Comparative study of outcomes using catheter-directed thrombolysis versus anticoagulation alone for management of submassive pulmonary embolism
Mawri S, Ali M, Gorgis S, Aurora L, Giordano M, Hegab S, Schwartz S, Koenig G. Comparative study of outcomes using catheter-directed thrombolysis versus anticoagulation alone for management of submassive pulmonary embolism. Catheter Cardiovasc Interventions. 2018;91:S14.
Catheter Cardiovasc Interventions
Background: Recent studies have suggested a clinical benefit towards a catheter-directed thrombolytic (CDT) approach to invasively manage patients with high-risk sub-massive PE. However, there is sparse data comparing the clinical outcomes of these patients when treated with CDT versus anticoagulation (AC) alone. Methods: From January 2013 until August 2017, we retrospectively identified 120 consecutive patients who underwent CDT at our institution for high-risk sub-massive PE. Using propensity score matching with the CDT group, we identified 120 patients out of 2054 patients who were confirmed, via manual chart review, to have PE and treated only with AC. Right ventricular strain on chest computed tomography (CT) was defined as right ventricle: left ventricle ratio≥1, and by echocardiography as right ventricular hypokinesis, right ventricular dilatation, and/or interventricular septal bowing. Results: Baseline demographics were similar between the CDT and AC alone groups. There was significant reduction in mean systolic pulmonary artery pressure (sPAP) after CDT from 49.7±13.6 mmHg to 37.6±14.0 (p=0.0001), whereas the change in sPAP in the AC only group was not significant, from 39.8±13.6 mmHg to 38.5±13.2 mmHg (p=0.582). There was significant improvement in proportion of RV dysfunction after CDT (97/108 (89.8%) to 48/100 (48.0%), p=0.0001) and a non-significant uptrend in proportion of RV dysfunction in the AC only group (69/120 (56.5%) to 32/47 (68.1%), p=0.109). Compared to AC only group, CDT group had significantly lower 30-day mortality (3/102 [2.5%] vs 15/119 [12.6%], p=0.009), a trend towards lower in-hospital mortality (2/120 [1.7%] vs 6/120 [5.0%], p=0.156) and 1-year mortality (8/81[9.9%] vs 17/117 [14.5%), p=0.335), shorter mean hospital length of stay (7.3±5.6 vs 9.5±9.1, p=0.028) and similar low rates of in-hospital complications. Conclusion: As compared to AC alone, CDT appears to be effective in improving RV function, reducing systolic PAP, associated with improved 30-day mortality, a trend towards improved in-hospital and 1 year clinical outcomes, shorter hospital length of stay and similiar complications for treatment of submassive PE. Large randomized clinical trials are needed to confirm these findings.