Outcomes of catheter‐directed thrombolysis vs. standard medical therapy in patients with acute submassive pulmonary embolism

Abstract

Background: Catheter-directed thrombolysis (CDL) is increasingly being used for the treatment of submassive and massive pulmonary embolism. Although this therapy has been shown to be effective at reducing right ventricle strain, the impact on clinical outcomes remains unclear. We therefore aimed to evaluate the outcomes of CDL compared to standard anticoagulation for submassive pulmonary embolism patients in a large cohort. Methods: We conducted a retrospective observational study of consecutive patients with a primary diagnosis of submassive pulmonary embolism admitted to an intensive care unit within our health system between June 2014 and April 2016. We compared the outcome of patients treated with systemic anticoagulation (medical therapy) vs. catheter-based delivery of tissue plasminogen activator (tPA) (CDL). CDL patients were matched with medical therapy controls using a propensity-score matching algorithm based on the components of the simplified pulmonary embolism severity index (sPESI) score. Results: Unadjusted mortality rates were 3.0% for CDL vs. 10.4% for medical therapy at 30 days and 8.1% for CDL vs. 22.9% for medical therapy at 1 year. In the propensity-score matched cohort, mortality rates were 3.1% for CDL vs. 6.1% for medical therapy at 30 days and 8.2% for CDL vs. 18.2% for medical therapy at 1 year. Length of stay was significantly shorter in the CDL group. The index admission bleeding and transfusion rates were not increased in the CDL group. Conclusions: In patients presenting with acute submassive pulmonary embolism who are admitted to an intensive care unit, the group treated with CDL experienced reduced mortality at 30 days and 1 year when compared to medical therapy without increase in bleeding. Further randomized studies are required to confirm these findings.

Efficacy and safety of hydro-mechanical defragmentation in intermediate- and high-risk pulmonary embolism

“…In our study, we observed a non-significant trend toward lower mortality rate in the HMD group compared to ST group mostly due to low power of our study. This agrees with Stephen D’Auria et al [ 25 ] and Lukas Hobohm et al [ 26 ] who reported lower mortality rate in PE patients who were subjected to CDT compared to patients who received ST.…”

Catheter Directed Thrombolysis in the Treatment of Acute Pulmonary Embolism: Early Hemodynamic Recovery and Improvement in Prognosis

“…Acute pulmonary embolism (APE) is a clinical syndrome that is a result of the obstruction of a pulmonary artery or its branches by a variety of endogenous or exogenous emboli. In the United States of America (USA), the incidence of APE is as high as 40-50 cases per 100,000 people per year, with a total of over 900,000 individuals affected by this disease [ 1 ]. Moreover, APE is also a common cause of sudden and unexpected deaths in China.…”

Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

“…The one RCT had low overall risk of bias ( 7 ). Among non-randomized studies, five had overall low risk of bias ( 14 , 16 , 18 – 20 ), three moderate risk ( 13 , 21 , 22 ), and two high risk ( 15 , 17 ). High risk of bias was mostly due to the selection of participants and missing data.…”