{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:12:18Z","timestamp":1777936338106,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2017,1,31]],"date-time":"2017-01-31T00:00:00Z","timestamp":1485820800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:p>Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis minimizes the risk of intracranial bleeding compared with systemic full-dose fibrinolytic therapy for pulmonary embolism (PE). However, major bleeding is nevertheless a potential complication. We analyzed the 150-patient SEATTLE II trial of submassive and massive PE patients to describe those who suffered major bleeding events following ultrasound-facilitated, catheter-directed, low-dose fibrinolysis and to identify risk factors for bleeding. Major bleeding was defined as GUSTO severe\/life-threatening or moderate bleeds within 72 hours of initiation of the procedure. Of the 15 patients with major bleeding, four (26.6%) developed access site-related bleeding. Multiple venous access attempts were more frequent in the major bleeding group (27.6% vs 3.6%; p&lt;0.001). All patients with major bleeding had femoral vein access for device delivery. Patients who developed major bleeding had a longer intensive care stay (6.8 days vs 4.7 days; p=0.004) and longer hospital stay (12.9 days vs 8.4 days; p=0.004). The frequency of inferior vena cava filter placement was 40% in patients with major bleeding compared with 13% in those without major bleeding ( p=0.02). Massive PE (adjusted odds ratio 3.6; 95% confidence interval 1.01\u201312.9; p=0.049) and multiple venous access attempts (adjusted odds ratio 10.09; 95% confidence interval 1.98\u201351.46; p=0.005) were independently associated with an increased risk of major bleeding. In conclusion, strategies for improving venous access should be implemented to reduce the risk of major bleeding associated with ultrasound-facilitated, catheter-directed, low-dose fibrinolysis. ClinicalTrials.gov Identifier: NCT01513759; EKOS Corporation 10.13039\/100006522<\/jats:p>","DOI":"10.1177\/1358863x16676355","type":"journal-article","created":{"date-parts":[[2016,12,2]],"date-time":"2016-12-02T20:15:20Z","timestamp":1480709720000},"page":"44-50","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":32,"title":["Risk factors for major bleeding in the SEATTLE II trial"],"prefix":"10.1177","volume":"22","author":[{"given":"Immad","family":"Sadiq","sequence":"first","affiliation":[{"name":"Vascular Medicine Division, Hartford Hospital, Hartford, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel Z","family":"Goldhaber","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping-Yu","family":"Liu","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Piazza","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Submassive and Massive Pulmonary Embolism Treatment with Ultrasound AcceleraTed ThromboLysis ThErapy (SEATTLE II) Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,1,31]]},"reference":[{"key":"bibr1-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.164493"},{"key":"bibr2-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X10380304"},{"key":"bibr3-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318214914f"},{"key":"bibr4-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.11.026"},{"key":"bibr5-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu283"},{"key":"bibr6-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.5990"},{"key":"bibr7-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu218"},{"key":"bibr8-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1302097"},{"key":"bibr9-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.09.027"},{"key":"bibr10-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0765"},{"key":"bibr11-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.04.020"},{"key":"bibr12-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309023291001"},{"key":"bibr13-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)07534-5"},{"key":"bibr14-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.07.117"},{"key":"bibr15-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(97)70108-X"},{"key":"bibr16-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.07.072"},{"key":"bibr17-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.5.1241"},{"key":"bibr18-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1378\/chest.108.4_Supplement.291S"},{"key":"bibr19-1358863X16676355","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2009.02.006"}],"container-title":["Vascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X16676355","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1358863X16676355","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X16676355","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:27:56Z","timestamp":1777692476000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1358863X16676355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,31]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,2]]}},"alternative-id":["10.1177\/1358863X16676355"],"URL":"https:\/\/doi.org\/10.1177\/1358863x16676355","relation":{},"ISSN":["1358-863X","1477-0377"],"issn-type":[{"value":"1358-863X","type":"print"},{"value":"1477-0377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,31]]}}}