The evidence on ultrasound‑enhanced, catheter‑directed thrombolysis for pulmonary embolism raises no major safety concerns over those of catheter‑directed thrombolysis (CDT) alone. With regard to efficacy, evidence of any enhancement of thrombolysis over CDT alone is inadequate in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do ultrasound‑enhanced, catheter‑directed thrombolysis (UE‑CDT) for pulmonary embolism (PE) should take the following actions.
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having UE‑CDT for PE (see section 7.1).
NICE encourages further research into ultrasound‑enhanced, catheter‑directed thrombolysis for PE. Ideally this should include comparative studies against catheter‑directed thrombolysis alone. Patient selection should be documented. The dose of thrombolytic agent used and the duration of thrombolysis should be reported, together with all complications. Outcome measures should include the success of thrombolysis (complete, partial or failed) and long‑term sequelae. NICE may update the guidance on publication of further evidence.