Violeta Jardin: Precision-Guided Systemic Thrombolysis in High-Risk Pulmonary Embolism
Violeta Jardin, General Manager at Haemoview Diagnostics, shared a post on LinkedIn about a recent article by András Kállai et al, published in Intensive Care Medicine Experimental, adding:
“Could thrombolysis for acute pulmonary embolism become safer and more personalized in the ICU?
A recent single-center randomized feasibility trial explored ClotPro-guided, low-dose, prolonged systemic thrombolysis for high- and intermediate-high-risk acute pulmonary embolism patients in the ICU.
Instead of giving every patient the standard 100 mg rtPA over 2 hours, the viscoelastometry-guided group received an individualized infusion adjusted according to real-time coagulation and fibrinolysis results, alongside repeated echocardiography to monitor right ventricular recovery.
The results are encouraging:
- Median rtPA dose was reduced to 32 mg
- Protocol adherence for viscoelastic testing was 95 percent
- Right ventricular dysfunction resolved in all patients in the guided group
- Severe thrombolysis-induced coagulopathy appeared reduced
- Fibrinogen supplementation could be targeted when needed
- Coagulation recovery after stopping thrombolysis appeared faster than with standard dosing
For ICU patients, this approach may offer a major advantage: effective reperfusion while preserving haemostatic reserve.
That is especially important in patients at high bleeding risk, where standard thrombolysis can be difficult to justify.
The study also highlights the value of specific ClotPro assays:
ECA test: the most sensitive assay for detecting tPA-related fibrinolytic activity, helping clinicians identify excessive or residual fibrinolysis in real time.
TPA test: useful for assessing whether the patient’s clotting system is responsive to tPA and for excluding fibrinolysis resistance.
This points toward an important future direction: precision-guided thrombolysis rather than fixed-dose thrombolysis.
A promising step for safer, more individualized PE management in critical care.”
Title: Personalised viscoelastometry-guided systemic thrombolysis for high- and intermediate-high-risk acute pulmonary embolism in the ICU: a single-centre randomised controlled interventional feasibility trial
Authors: András Kállai, Anna Párkányi, Máté Berczi, Dalma Skultéti, János Domonkos Stubnya, Hanna Dóra Szász, Gergely Szombath, Adrienne Fehér, Zsolt Dániel Iványi, János Gál, János Fazakas
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