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  • Title: Combined catheter thrombus fragmentation and fibrinolysis for acute pulmonary embolism.
    Author: Gao H, Huang GY, Ma LL, Wang LX.
    Journal: Intern Med J; 2011 Sep; 41(9):687-91. PubMed ID: 21899681.
    Abstract:
    AIMS: The aim of this study is to evaluate the effectiveness and safety of combined catheter thrombus fragmentation and fibrinolysis for acute pulmonary embolism (PE). METHODS: Forty-six patients (19 men and 27 women, average age 52.3 ± 13.4 years) with acute PE and right ventricular dysfunction were treated by mechanical thrombus fragmentation with a percutaneous transluminal coronary angioplasty guide catheter. Urokinase was injected into the culprit pulmonary artery after catheter thrombus fragmentation in all patients. RESULT: Clinical success was achieved in all patients. After the treatment, the average pulmonary artery pressure was decreased from 57.2 ± 6.2 to 36.3 ± 4.1 mmHg (P < 0.01). The oxygen saturation rate was raised from 81.4 ± 4.3% to 97.0 ± 2.0% (P < 0.01), and the right ventricular function was improved. There was no in-hospital mortality and there were no major complications, such as haemorrhage. Patients were treated with warfarin for 6 months with no signs of PE recurrence during the follow up. CONCLUSION: In PE patients with right ventricular dysfunction and unstable haemodynamics, combined catheter thrombus fragmentation and thrombolysis appears to be a useful therapeutic strategy. In PE patients with right ventricular dysfunction and stable haemodynamics, randomized trials are still required to show that combination of catheter-directed thrombus fragmentation and thrombolysis is superior to standard anticoagulation.
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