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intravenous catheter-directed thrombolysis
Indications:
- intermediate & high-risk pulmonary embolism* [2]
- perhaps not deep vein thrombosis [1]
* lower mortality vs systemic thrombolysis (RR=0.43 vs systemic thrombolysis) & (RR=0.36 vs anticoagulation) [2]
Procedure:
- intravenous catheter of pulmonary artery catheter directed thrombolysis
- uses < 1/4 dose of thrombolytic agent vs systemic thrombolysis
Complications:
- pulmonary embolism (18% vs 11%) for anticoagulation alone
- intracranial hemorrhage (0.9% vs 0.3%)
- major bleeding & intracranial hemorrhage less than systemic thrombolysis & similar to anticoagulation [2]
- need for vena cava filter placement (35% vs 16%)
- longer & more expensive hospital stays [1]
Related
deep vein thrombosis (DVT)
General
catheter-directed thrombolysis
References
- Bashir R et al
Comparative Outcomes of Catheter-Directed Thrombolysis Plus
Anticoagulation vs Anticoagulation Alone to Treat Lower-
Extremity Proximal Deep Vein Thrombosis.
JAMA Intern Med. Published online July 21, 2014
PMID: 25047081
http://archinte.jamanetwork.com/article.aspx?articleid=1889011
- Planer D et al.
Catheter-directed thrombolysis compared with systemic thrombolysis and
anticoagulation in patients with intermediate- or high-risk pulmonary embolism:
Systematic review and network meta-analysis.
CMAJ 2023 Jun 19; 195:E833.
PMID: 37336568 PMCID: PMC10281204 Free PMC article
https://www.cmaj.ca/content/195/24/E833