Department of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland.
Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
Viruses. 2022 Jul 22;14(8):1606. doi: 10.3390/v14081606.
Fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT) rapidly improves hemodynamic parameters and reverses right ventricular dysfunction caused by acute pulmonary embolism (PE). The effectiveness of USAT for acute PE associated with coronavirus disease 2019 (COVID-19) is unknown. The study population of this cohort study consisted of 36 patients with an intermediate-high- or high-risk acute PE treated with a fixed low-dose USAT protocol (r-tPA 10-20 mg/15 h). Of these, 9 patients tested positive for COVID-19 and were age-sex-matched to 27 patients without COVID-19. The USAT protocol included, beyond the infusion of recombinant tissue plasminogen activator, anti-Xa-activity-adjusted unfractionated heparin therapy (target 0.3-0.7 U/mL). The study outcomes were the invasively measured mean pulmonary arterial pressure (mPAP) before and at completion of USAT, and the National Early Warning Score (NEWS), according to which more points indicate more severe hemodynamic impairment. Twenty-four (66.7%) patients were men; the mean age was 67 ± 14 years. Mean ± standard deviation mPAP decreased from 32.3 ± 8.3 to 22.4 ± 7.0 mmHg among COVID-19 patients and from 35.4 ± 9.7 to 24.6 ± 7.0 mmHg among unexposed, with no difference in the relative improvement between groups ( = 0.84). Within 12 h of USAT start, the median NEWS decreased from six (Q1-Q3: 4-8) to three (Q1-Q3: 2-4) points among COVID-19 patients and from four (Q1-Q3: 2-6) to two (Q1-Q3: 2-3) points among unexposed ( = 0.29). One COVID-19 patient died due to COVID-19-related complications 14 days after acute PE. No major bleeding events occurred. Among patients with COVID-19-associated acute PE, mPAP rapidly decreased during USAT with a concomitant progressive improvement of the NEWS. The magnitude of mPAP reduction was similar in patients with and without COVID-19.
固定剂量超声辅助导管溶栓（USAT）可迅速改善血流动力学参数并逆转急性肺栓塞（PE）引起的右心室功能障碍。USAT 治疗伴有 2019 年冠状病毒病（COVID-19）的急性 PE 的有效性尚不清楚。这项队列研究的研究人群由 36 名接受固定低剂量 USAT 方案（r-tPA 10-20 mg/15 h）治疗的中高危急性 PE 患者组成。其中，9 名 COVID-19 检测呈阳性，与 27 名未感染 COVID-19 的患者进行了年龄和性别匹配。USAT 方案除了输注重组组织纤溶酶原激活物外，还包括抗 Xa 活性调整的未分级肝素治疗（目标 0.3-0.7 U/mL）。研究结果是在 USAT 治疗前后通过侵入性测量的平均肺动脉压（mPAP）和国家早期预警评分（NEWS），其中分数越高表示血流动力学损伤越严重。24 名（66.7%）患者为男性；平均年龄为 67 ± 14 岁。COVID-19 患者的平均 ± 标准偏差 mPAP 从 32.3 ± 8.3 降至 22.4 ± 7.0 mmHg，未暴露组从 35.4 ± 9.7 降至 24.6 ± 7.0 mmHg，两组间相对改善无差异（ = 0.84）。在 USAT 开始后 12 小时内，COVID-19 患者的 NEWS 中位数从 6 分（Q1-Q3：4-8）降至 3 分（Q1-Q3：2-4），未暴露组从 4 分（Q1-Q3：2-6）降至 2 分（Q1-Q3：2-3）（ = 0.29）。1 名 COVID-19 患者在急性 PE 后 14 天因 COVID-19 相关并发症死亡。未发生重大出血事件。在 COVID-19 相关急性 PE 患者中，USAT 期间 mPAP 迅速下降，同时 NEWS 逐渐改善。有和没有 COVID-19 的患者的 mPAP 降低幅度相似。
