Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Time to Systemic Thrombolysis in Confirmed Massive Pulmonary Embolism in a Single Center

Session Title
TP88 - TP088 LUCY IN THE SKY WITH DIAMONDS - PULMONARY EMBOLISM, CTEPH, THROMBOSIS, AND COVID19: CLINICAL ADVANCES
Abstract
A3728 - Time to Systemic Thrombolysis in Confirmed Massive Pulmonary Embolism in a Single Center
Author Block: B. Kwok1, A. Katz2, F. Dikengil3, S. Gayen3, M. Zheng3, P. Rali3, S. B. Brosnahan1; 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, NY, United States, 2Department of Pharmacy, NYU Langone Health, New York, NY, United States, 3Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
Rationale: Systemic thrombolysis is a preferred treatment for high-risk pulmonary embolism (PE) given its availability and ease of administration. Administration of thrombolysis requires careful risk-benefit analysis, especially in medically complex patients, due to risk of catastrophic adverse outcomes. Therefore, the exact timing and threshold for thrombolysis in high-risk pulmonary embolism is not well described. Here, we present a retrospective study of the timing, dosing and administration of thrombolysis in cases of imaging-confirmed high-risk PE.
Methods: A retrospective chart review was performed on all patients in a tertiary urban hospital system who received alteplase between January 2016 and February 2020. Those who received alteplase as catheter-directed therapy (CDT) or for reasons other than confirmed or suspected pulmonary embolism (PE) were excluded. Data including demographics, timing of drug administration, laboratory values, and adverse events were collected. Statistical analysis was performed with IBM SPSS Statistics (version 25).
Results: tPA was administered to 58 subjects for suspected and confirmed PE. Seventeen (29.3%) had high-risk PE on computed tomography pulmonary angiogram (CTPA). Among the 17, 10 (58.8%) had absolute contraindication(s) and 3 (17.6%) had relative contraindication(s) to tPA. Eleven (65%) suffered cardiac arrest after diagnosis, but before tPA was administered. Median time between diagnosis and tPA administration was 87 minutes (IQR 146.5 mins); median time from the start of cardiac arrest to tPA administration was 11 mins (IQR 9.5 mins). 8/11 received alteplase boluses with similar dosing strategies. Eight had ROSC and two required mechanical circulatory support; six of these survived to hospital discharge. There were no cases of intracranial hemorrhage. There were 3 major bleeding events in those who suffered cardiac arrest; all 3 had ROSC and 2 survived to hospital discharge. Timing and dosing of tPA were not associated with a statistically significant survival rate.
Conclusions: Patients high-risk PE and contraindications to tPA require mobilization of many resources. Additionally, these patients may be medically complex and require careful risk-benefit analysis with a multidisciplinary team that may include critical care, cardiothoracic surgery, vascular surgery, and pharmacy. There is a large variability in time-to-tPA administration, yet tPA doses remained consistent. This is interesting as tPA is weight-based in other thrombotic diseases. A Pulmonary Embolism Response Team (PERT) may be best poised to tackle these complicated tasks, as long as it does not delay treatment.