C23-22 Catheter Directed Thrombolysis Versus Systemic Therapy in Pulmonary Embolism: A Decade of Experience From the National Inpatient Sample (2010-2021)

Abstract Rationale High and intermediate risk pulmonary embolism (PE) contributes significantly to in hospital morbidity and 5-10% of in hospital deaths. Thrombolytic therapy either via systemic intravenous tissue plasminogen activator (IV-tPA) or catheter directed thrombolysis (CDT) remains central to management, however, comparative national data on utilization and outcomes of thrombolytic therapy for PE remain limited. Methods Using the National Inpatient Sample data from 2010 to 2021, adult hospitalizations for acute PE were identified using ICD 9 code 415.1 and ICD 10 code I26. Cases receiving IV-tPA or CDT were identified using procedural codes. Temporal trends, in-hospital mortality, length of stay (LOS) and complications were compared between treatment groups using weighted analyses. Results Among 1,940,718 hospitalizations with acute pulmonary embolism, the use of thrombolytic therapy increased from 2010 to 2021 for both systemic intravenous tissue plasminogen activator (IV-tPA) and catheter-directed thrombolysis (CDT). Utilization of IV-tPA rose from 1.8% to 2.%, while CDT increased from 1.4% to 3.9%. Compared to IV-tPA, patients treated with CDT were more likely to be older (42.7% vs 39.3% were aged 65 years or above) and male (50.8% vs 48.7%). CDT was associated with significantly lower in hospital mortality (6.7% versus 11.1%, p 0.01), shorter median length of stay (5 versus 6 days, p 0.01) and fewer discharges to facilities (13.7% versus 19.4 %, p 0.01). Rates of major complications were lower in the CDT group, including intracranial hemorrhage (0.4% versus 1.2%), cardiac arrest (1.7% versus 7.3%), myocardial infarction (4.7% versus 5.1%) and need for mechanical ventilation (6.7% versus 16.1%). However, use of extracorporeal membrane oxygenation (0.7% versus 0.2 %) and surgical embolectomy (1.2% versus 0.7%) was higher among CDT patients. Conclusions From 2010 to 2021, utilization of thrombolytic therapy, particularly catheter-directed techniques increased among PE hospitalizations. CDT was associated with lower in hospital mortality, shorter stays and fewer complications compared to systemic IV-tPA. These findings support the expanding role of catheter based interventions as a preferred therapeutic approach for patients with high and intermediate risk pulmonary embolism. Further prospective studies are warranted to confirm long term outcomes and optimize patient selection for CDT. This abstract is funded by: None