Abstract No. 177 ▪ FEATURED ABSTRACT A Comparison of Post-Procedural Hemoglobin in Catheter-Directed Thrombolysis vs. Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism

To compare post-procedural changes in hemoglobin (HGB) following catheter-directed thrombolysis (CDL) vs. large-bore aspiration thrombectomy (LBAT) of acute pulmonary embolism (PE). Single-center retrospective review of acute high and intermediate-risk PE patients treated with CDL or LBAT between 12/2009 and 9/2023. The LBAT (FlowTriever, Inari Medical, Irvine, CA) group was divided according to usage of an autotransfusion device (ATD) (FlowSaver, Inari Medical). Patients were excluded if they received systemic tPA, had both LBAT and CDL in the same procedure, or had missing HGB data. There were 166 patients in the CDL group (56±15 years). The LBAT group included patients treated without an ATD (LBAT, n=58, 61±16 years) and with ATD (LBATw, n=47, 62±15 years). The age difference was significant (p=.01). The number of patients with intermediate risk PE was 91.6%, 89.6% and 87.3% in the CDL, LBAT and LBATw groups, respectively (p=.2). The remaining patients in each group had high risk PE. LBAT was performed using 16F, 20F and 24F catheters. The mean CDL duration was 25±7 hours, with a mean tPA dose of 27±5 mg. Endpoints included change in HGB between pre- and post-procedural measurements, as well as hemorrhagic adverse events (AE). The mean HGB changes in the CDL, LBAT, and LBATw groups were -1.3±1.3 g/dL, -1.6±0.98 g/dL, and -1.1±0.9 g/dL, respectively (p=.1). The estimated blood loss (EBL) during LBAT was 275.3±109.5 mL without ATD and 93.5±7 mL with ATD (p ≤ .001). The last HGB prior to initial procedure was not significantly different between groups (p=.5), with 13.2±2 g/dL, 13.3±2.4 g/dL, and 12.8±2.2 g/dL in the CDL, LBAT, and LBATw groups, respectively. The first HGB after the final procedure (< 24hrs) was not significant between groups (p=.7). GUSTO minor hemorrhagic AE rate was 3.6% in CDL, 12.1% in LBAT, and 14.9% in LBATw (p=.01). There were 1.2%, 3.4%, and 6.4% moderate hemorrhagic AE in the CDL, LBAT, and LBATw groups, respectively (p=.1). There were 1.2% major hemorrhagic AE in the CDL group and none in either LBAT group (p=.5). Blood transfusions were administered to 1.2%, 3.5% and 6.4% of patients in the CDL, LBAT and LBATw groups, respectively (p=.8). There were no procedure-related deaths in any group. There was no significant difference in post-procedural HGB change between CDL and LBAT regardless of usage of an ATD. There was significantly lower EBL in the LBAT group using ATD. There were more minor hemorrhagic AE in the LBAT groups. Moderate and severe AE rates were not different between the groups.