Safety of catheter‐directed thrombolysis for massive and submassive pulmonary embolism: Results of a multicenter registry and meta‐analysis

Abstract

CDT is associated with a low major complication rate. Randomized studies are needed to evaluate its efficacy relative to anticoagulation alone. © 2017 Wiley Periodicals, Inc.

Systemic Thrombolysis, Catheter‐Directed Thrombolysis, and Anticoagulation for Intermediate‐risk Pulmonary Embolism: A Simulation Modeling Analysis

“…However, the true rate of ICH after CDT is not known. A recent meta‐analysis of 860 patients by Bloomer et al . found an ICH rate of 0.35% ( n = 860) after CDT, which is lower than our base‐case assumption.…”

“…found an ICH rate of 0.35% ( n = 860) after CDT, which is lower than our base‐case assumption. In contrast, in the same article, Bloomer et al . also report the results of a registry in which two of 137 (1.46%) patients had ICH after CDT.…”

Safety of Therapeutic Anticoagulation with Low-Molecular-Weight Heparin or Unfractionated Heparin Infusion during Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

“…In comparison, the current study found a combined GUSTO-major and GUSTO-moderate hemorrhagic rate of 3.8% and an intracranial hemorrhage rate of 0.6%. When comparing the subgroup of patients treated with full-dose therapeutic heparin (n ¼ 111), the GUSTO-major (2.7%), GUSTO-moderate (1.8%), and GUSTO-minor (3.6%) complication rates were lower than previously reported by Bloomer et al (15). The current study also reports a subgroup of patients (n ¼ 45) who were treated with full-dose therapeutic LMWH, which demonstrated very low GUSTO-major (0%), GUSTO-moderate (2.2%), and GUSTO-minor (0%) complication rates.…”

“…(3) classification), thus attempting to clarify the question of anticoagulation during CDT while facilitating future comparisons and meta-analyses (13). The current study reports GUSTO-major (1.9%, including a single intracranial hemorrhage), GUSTO-moderate (1.9%), and GUSTO-minor (2.6%) complication rates that are similar (13,14) or lower (15,16) than those reported in studies using full therapeutic-dose anticoagulation (14,15), the GUSTO (16) classification, and in a meta-analysis (13). The SEATTLE II trial (16), the largest CDT trial to use GUSTO criteria, reported 0.7% GUSTO-major complications (1 groin Final systolic PAP (mmHg) 42.5 ± 11.6 42.5 ± 11.9 42.5 ± 11.5 .9…”

Therapeutic Intervention for Pulmonary Embolism: Show me the data!

“…In this issue of Catheterization and Cardiovascular Interventions , Bloomer and colleagues present results collated from a two‐center registry of consecutive patients treated with catheter‐directed thrombolysis (CDT) for acute massive and submassive pulmonary embolism (PE). In the second part of this investigation, Bloomer et al conducted a meta‐analysis of contemporary studies of CDT for PE, while incorporating their institutional results into the pooled data of articles included for the systematic review.…”