Clinical outcomes of very elderly patients treated with ultrasound-assisted catheter-directed thrombolysis for pulmonary embolism: a systematic review.
Mauricio Castillo-PerezCarlos Jerjes-SanchezDavid RodríguezJose Gildardo Paredes-VazquezJathniel PanneflekMauricio Vazquez-GuajardoPublished in: Journal of thrombosis and thrombolysis (2021)
Pulmonary embolism (PE) is a significant cause of death in the very elderly (≥ 75 years) population. Ultrasound-assisted catheter-directed thrombolysis (USCDT) emerges to improve thrombolysis safety and efficacy. However, outcomes in very elderly patients are unknown, as randomized controlled trials exclude this population. Recently, we demonstrated acute kidney injury (AKI) and ischemic hepatitis in an octogenarian intermediate-risk PE patient treated with USCDT. Considering the lack of evidence, we undertook a systematic review to evaluate the clinical outcomes in very elderly PE patients treated with USCDT. We searched for very elderly PE patients treated with USCDT from 2008 to 2019. Additionally, we conducted another systematic review without age restriction to update previous evidence and compare both populations. We also did an exploratory analysis to determine if thrombolysis was followed based on current guidelines or impending clinical deterioration factors. We identified 18 very elderly patients (age 79.2, 75-86), mostly female and with intermediate-risk PE. We found an intracranial hemorrhage (ICH), and a right pulmonary artery rupture. Additionally, two significant bleedings complicated with transient AKI, and one case of AKI and ischemic hepatic injury. The patients who survived all had clinical and echocardiographic in-hospital improvement. Despite low rt-PA doses, ICH and major bleeding remain as feared complications. Thrombolysis decision was driven by impending clinical deterioration factors instead of international guideline recommendations. Our data do not suggest prohibitive risk associated with USCDT in very elderly intermediate and high-risk PE patients. Despite long-term infusions and right ventricular dysfunction, AKI and ischemic hepatic injury were infrequent.
Keyphrases
- pulmonary embolism
- acute kidney injury
- inferior vena cava
- middle aged
- pulmonary artery
- systematic review
- community dwelling
- cardiac surgery
- pulmonary hypertension
- ejection fraction
- coronary artery
- ischemia reperfusion injury
- pulmonary arterial hypertension
- randomized controlled trial
- newly diagnosed
- cerebral ischemia
- end stage renal disease
- meta analyses
- risk factors
- adipose tissue
- type diabetes
- left ventricular
- emergency department
- atrial fibrillation
- prognostic factors
- mitral valve
- clinical trial
- patient reported outcomes
- electronic health record
- skeletal muscle
- study protocol
- machine learning
- adverse drug
- optical coherence tomography
- data analysis
- optic nerve