Key result
Mechanical thrombectomy for pulmonary embolism was associated with a higher risk of ISTH-modeled major bleeding compared to USCDT (15.4% vs 11.8%; OR 1.37; 95% CI 1.10-1.74; P<0.001).
Why the study?
Does mechanical thrombectomy improve clinical outcomes or safety compared to ultrasound-assisted catheter-directed thrombolysis in patients with pulmonary embolism?
Does mechanical thrombectomy improve clinical outcomes or safety compared to ultrasound-assisted catheter-directed thrombolysis in patients with pulmonary embolism?
Answers are grounded in this paper and cite their sources.
In a real-world analysis, mechanical thrombectomy for pulmonary embolism showed similar short-term mortality to ultrasound-assisted catheter-directed thrombolysis but was associated with higher rates of major bleeding and intracranial hemorrhage, though unmeasured confounding may exist.
Modern Treatment of Pulmonary Embolism (USCDT vs MT): Results From a Real-World, Big Data Analysis (REAL-PE)Journal of the Society for Cardiovascular Angiography & InterventionsVol. 3Issue 1101192PreviewAdvanced therapies are increasingly utilized to treat pulmonary embolism (PE). A unique data platform allows access to electronic health record data for comparison of the safety of PE therapies. Full-Text PDF Open Access Acute pulmonary embolism (PE) is a leading preventable cause of in-hospital death and the third most common cause of vascular death in the United States.1Bikdeli B. Wang Y. Jimenez D. et al.Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999-2015.JAMA. 2019; 322: 574-576https://doi.org/10.1001/jama.2019.8594Crossref PubMed Scopus (67) Google Scholar PE events range from incidental defects found on imaging studies for other purposes to severe illness with circulatory collapse. Among those with hemodynamic stability, patients who present with imaging evidence of right ventricular dysfunction and/or elevated cardiac biomarkers (ie, intermediate-risk PE) have a higher risk for decompensation or death compared with those without.2Konstantinides S.V. Meyer G. Becattini C. et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603https://doi.org/10.1093/eurheartj/ehz405Crossref PubMed Scopus (2198) Google Scholar Although systemic fibrinolysis is effective, it is not the standard treatment for intermediate-risk PE since the benefits are small and offset by major and intracranial hemorrhage (ICH) risk.2Konstantinides S.V. Meyer G. Becattini C. et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603https://doi.org/10.1093/eurheartj/ehz405Crossref PubMed Scopus (2198) Google Scholar Among patients with hemodynamic instability (ie, high-risk PE), systemic fibrinolysis is the standard of care in many patients; however, it may be compounded by contraindications or other complexities in care.1Bikdeli B. Wang Y. Jimenez D. et al.Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999-2015.JAMA. 2019; 322: 574-576https://doi.org/10.1001/jama.2019.8594Crossref PubMed Scopus (67) Google Scholar Data from routine practice indicates underutilization of reperfusion in many patients with high-risk PE.3Zuin M. Piazza G. Barco S. et al.Time-based reperfusion in hemodynamically unstable pulmonary embolism patients: does early reperfusion therapy improve survival?.Eur Heart J Acute Cardiovasc Care. 2023; 12: 714-720https://doi.org/10.1093/ehjacc/zuad080Crossref PubMed Scopus (2) Google Scholar In this context, alternative therapies that can offer safe and effective reperfusion are needed. Endovascular therapies for PE arose as promising technologies for this specific group of patients.4Götzinger F. Lauder L. Sharp A.S.P. et al.Interventional therapies for pulmonary embolism.Nat Rev Cardiol. 2023; 20: 670-684https://doi.org/10.1038/s41569-023-00876-0Crossref PubMed Scopus (8) Google Scholar These therapies include catheter-directed thrombolysis, ultrasound-assisted catheter-directed thrombolysis (USCDT), and various percutaneous thrombectomy tools. Although showing promising results in reducing right ventricular dysfunction and hemodynamic compromise improvement in small randomized controlled trials (RCT) and registries, these therapies have not been compared with either standard anticoagulation or systemic fibrinolysis in adequately powered clinical outcomes trials. Professional societies do not recommend these therapies as an upfront treatment for patients with intermediate-risk PE.2Konstantinides S.V. Meyer G. Becattini C. et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603https://doi.org/10.1093/eurheartj/ehz405Crossref PubMed Scopus (2198) Google Scholar,5Giri J. Sista A.K. Weinberg I. et al.Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: A scientific statement from the American Heart Association.Circulation. 2019; 140: e774-e801https://doi.org/10.1161/CIR.0000000000000707Crossref PubMed Scopus (223) Google Scholar In this issue of JSCAI, the REAL-PE investigators report the short-term clinical outcomes of patients with PE treated with USCDT or mechanical thrombectomy (MT).6Monteleone P. Ahern R. Banerjee S. et al.Modern treatment of pulmonary embolism (USCDT versus MT): results from real-world, big data analysis (REAL-PE).J Soc Cardiovasc Angiogr Interv. 2023; https://doi.org/10.1016/j.jscai.2023.101192Abstract Full Text Full Text PDF Scopus (2) Google Scholar The authors analyzed data from an electronic health record-based platform, encompassing 83 million patients to identify those treated with USCDT or MT for PE. Baseline characteristics, laboratory test results, and in-hospital mortality were extracted through specific codes from standard ontologies. The authors modeled 2 bleeding definitions: the International Society on Thrombosis and Haemostasis (ISTH) and the Bleeding Academic Research Consortium (BARC) 3b, which required codes for major bleeding, plus a decrease in hemoglobin concentration of ≥2 g/dL,7Schulman S. Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost. 2005; 3: 692-694https://doi.org/10.1111/j.1538-7836.2005.01204.xAbstract Full Text Full Text PDF PubMed Scopus (3612) Google Scholar or ≥5 g/dL decrease in hemoglobin regardless if they required blood transfusion.8Mehran R. Rao S.V. Bhatt D.L. et al.Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.Circulation. 2011; 123: 2736-2747https://doi.org/10.1161/CIRCULATIONAHA.110.009449Crossref PubMed Scopus (3260) Google Scholar They also explored ICH by using codes. The authors analyzed outcomes in 2 cohorts depending on the date in which the index procedure was performed: primary analysis (January 2009 to May 2023) and contemporary analysis (January 2018 to May 2023). Among the 83,612,413 patients with available data, 535,567 (0.6%) had a diagnosis of PE. In the primary analysis, 2259 (0.4%) patients (n = 1577 USCDT, n = 682 MT) met the selection criteria, and 1798 (0.3%) (n = 1137 USCDT, n = 661 MT) met the selection criteria for the contemporary analysis. In the primary analysis, a larger proportion of patients were female, aged ≥60 y, or had a cancer diagnosis in MT-treated compared with the USCDT cohort. In both primary and contemporary analyses, there were no differences in in-hospital mortality between the USCDT-treated and MT-treated cohorts (primary: 2.6% vs. 3.7%; P = .167 and contemporary: 2.9% vs. 3.5%; P = .497), or in 30-d all-cause readmission rates. In both analyses, the MT-treated cohort had a higher rate of blood transfusion at 7 d, ISTH-modeled, as well as BARC 3b-modeled major bleeding (primary: 11.8% vs. 15.4%; P < .001 and contemporary: 10.6% vs. 15.4%; P < .001). The authors conducted a multivariable analysis of variables associated with major bleeding. In both analyses, the use of MT was associated with a higher risk of ISTH-modeled (primary: odds ratio [OR], 1.37; 95% CI, 1.10-1.74; and contemporary: OR, 1.61; 95% CI, 1.23-2.10) and BARC 3b-modeled major bleeding (primary: OR, 1.23; 95% CI, 0.96-1.58; and contemporary: OR, 1.76; 95% CI, 1.40-2.22). Although there was no difference in the rate of ischemic stroke between the MT-treated and USCDT-treated cohorts, the study reported a higher rate of ICH in the MT-treated cohort compared with the USCDT cohort (primary: 0.3% vs. 1.3%; P = .005 and contemporary: 0.4% vs. 1.4%; P < .015). The REAL-PE investigators should be commended for this investigation, which provides insight into a clinically relevant topic. Strengths of the study include the large sample size and the comparison of 2 devices frequently used in clinical practice, with anticipation for results from an ongoing randomized trial, but no current high-quality data on head-to-head comparison.9Gonsalves C.F. Gibson C.M. Stortecky S. et al.Randomized controlled trial of mechanical thrombectomy versus catheter-directed thrombolysis for acute hemodynamically stable pulmonary embolism: rationale and design of the Peerless study.Am Heart J. 2023; 266: 128-137https://doi.org/10.1016/j.ahj.2023.09.002Crossref PubMed Scopus (4) Google Scholar The comparative mortality and readmission rates are helpful additions to the literature. Blood loss with MT is also known in the literature, and these data provide additional evidence from a large-scale study. Observational data are also helpful in providing routine practice insights that may complement findings from clinical trials. That said, this analysis warrants further insights. Patients in the MT-treated cohort were older, had a higher frequency of cancer-associated PE, and had lower use of prior direct oral anticoagulants. Indeed, prior studies have reported that patients with cancer-associated PE exhibit worse clinical outcomes than those with noncancer-associated PE.10Cai B. Bedayat A. George E. et al.Malignancy and acute pulmonary embolism: risk stratification including the right to left ventricle diameter ratio in 1596 subjects.J Thorac Imaging. 2013; 28: 196-201https://doi.org/10.1097/RTI.0b013e3182870bf9Crossref PubMed Scopus (11) Google Scholar Notably, age and cancer are important predictors of bleeding and cerebrovascular events. Moreover, to our knowledge, no major prior study, including prospective registries or those based on chart review, has reported a potential safety signal for ICH with MT.11Elmoghrabi A. Shafi I. Abdelrahman A. et al.Outcomes of catheter-based pulmonary artery embolectomy in patients with sub-massive to massive pulmonary embolism.Cureus. 2023; 15e34877https://doi.org/10.7759/cureus.34877Crossref PubMed Google Scholar,12Wible B.C. Buckley J.R. Cho K.H. Bunte M.C. Saucier N.A. Borsa J.J. Safety and efficacy of acute pulmonary embolism treated via large-bore aspiration mechanical thrombectomy using the Inari FlowTriever device.J Vasc Interv Radiol. 2019; 30: 1370-1375https://doi.org/10.1016/j.jvir.2019.05.024Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar The mechanism proposed by the authors for such a large between-group difference in ICH, while not implausible, is also improbable. Research using administrative claims codes (such as International Classification of Diseases codes) would benefit from validation of the approach not only for the intended disease condition (PE)13Bikdeli B. Lo Y.C. Khairani C.D. et al.Developing validated tools to identify pulmonary embolism in electronic databases: rationale and design of the PE-EHR+ study.Thromb Haemost. 2023; 123: 649-662https://doi.org/10.1055/a-2039-3222Crossref PubMed Scopus (3) Google Scholar but also for that of outcomes (such as ICH in this case) against adjudication of patient-level records by independent physicians. Moreover, it should be highlighted that the use of MT in clinical practice before 2018 was marginal. Table 114Kucher N. Boekstegers P. Müller O.J. et al.Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.Circulation. 2014; 129: 479-486https://doi.org/10.1161/CIRCULATIONAHA.113.005544Crossref PubMed Scopus (741) Google Scholar, 15Piazza G. Hohlfelder B. Jaff M.R. et al.A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study.JACC Cardiovasc Intv. 2015; 8: 1382-1392https://doi.org/10.1016/j.jcin.2015.04.020Crossref PubMed Scopus (617) Google Scholar, 16Tapson V.F. Sterling K. Jones N. et al.A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial.JACC Cardiovasc Intv. 2018; 11: 1401-1410https://doi.org/10.1016/j.jcin.2018.04.008Crossref PubMed Scopus (273) Google Scholar, 17Tu T. Toma C. Tapson V.F. et al.A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study.JACC Cardiovasc Intv. 2019; 12: 859-869https://doi.org/10.1016/j.jcin.2018.12.022Crossref PubMed Scopus (265) Google Scholar, 18Sista A.K. Horowitz J.M. Tapson V.F. et al.Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial.JACC Cardiovasc Intv. 2021; 14: 319-329https://doi.org/10.1016/j.jcin.2020.09.053Crossref PubMed Scopus (133) Google Scholar, 19Avgerinos E.D. Jaber W. Lacomis J. et al.Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial.JACC Cardiovasc Intv. 2021; 14: 1364-1373https://doi.org/10.1016/j.jcin.2021.04.049Crossref PubMed Scopus (67) Google Scholar, 20Kroupa J. Buk M. Weichet J. et al.A pilot randomised trial of catheter-directed thrombolysis or standard anticoagulation for patients with intermediate-high risk acute pulmonary embolism.EuroIntervention. 2022; 18: e639-e646https://doi.org/10.4244/EIJ-D-21-01080Crossref PubMed Scopus (12) Google Scholar, 21Sadeghipour P. Jenab Y. Moosavi J. et al.Catheter-directed thrombolysis vs anticoagulation in patients with acute intermediate-high-risk pulmonary embolism: the CANARY randomized clinical trial.JAMA Cardiol. 2022; 7: 1189-1197https://doi.org/10.1001/jamacardio.2022.3591Crossref PubMed Scopus (24) Google Scholar, 22Toma C. Jaber W.A. Weinberg M.D. et al.Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism.EuroIntervention. 2023; 18: 1201-1212https://doi.org/10.4244/EIJ-D-22-00732Crossref PubMed Scopus (30) Google Scholar, 23Silver M.J. Gibson C.M. Giri J. et al.Outcomes in high-risk pulmonary embolism patients undergoing FlowTriever mechanical thrombectomy or other contemporary therapies: results from the FLAME study.Circ Cardiovasc Interv. 2023; 16e013406https://doi.org/10.1161/CIRCINTERVENTIONS.123.013406Crossref PubMed Scopus (6) Google Scholar summarizes selected clinical outcomes of recent studies assessing the outcomes of different endovascular therapies, including USCDT and MT. Although the all-cause death rate of the REAL-PE study appears similar to prior studies, the rates of bleeding and transfusions are remarkably higher than in prior studies using the devices. Notably, the methodology used for outcome ascertainment (through codes) in the REAL-PE study differs substantially from the prior studies that used clinical data, in some cases with clinical event committees for event adjudication. A prior study has suggested that claims data has a good agreement compared to event adjudication committees for identifying deaths but poor agreement with high specificity for bleeding and stroke.24Faridi K.F. Tamez H. Butala N.M. et al.Comparability of event adjudication versus administrative billing claims for outcome ascertainment in the DAPT study: findings from the EXTEND-DAPT study.Circ Cardiovasc Qual Outcomes. 2021; 14e006589https://doi.org/10.1161/CIRCOUTCOMES.120.006589Crossref PubMed Scopus (16) Google ScholarTable 1Outcomes in prior prospective studies of endovascular therapies for pulmonary embolism.StudyMethodologyAll-cause deathIntracranial bleedingMajor bleedingBlood transfusionsLength of stay (d)ULTIMA,14Kucher N. Boekstegers P. Müller O.J. et al.Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.Circulation. 2014; 129: 479-486https://doi.org/10.1161/CIRCULATIONAHA.113.005544Crossref PubMed Scopus (741) Google Scholar intermediate-risk, 2013 (n = 59)RCT comparing USCDT vs. heparin. Primary outcome: RV/LV ratio at 24 h. Clinical outcomes at 90 dUSCDT: 0USCDT: 0USCDT: 0NANASEATTLE II,15Piazza G. Hohlfelder B. Jaff M.R. et al.A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study.JACC Cardiovasc Intv. 2015; 8: 1382-1392https://doi.org/10.1016/j.jcin.2015.04.020Crossref PubMed Scopus (617) Google Scholar intermediate and high-risk, 2015 (n = 150)Single-arm, multicenter study describing safety and efficacy of USCDTIn-hospital: 2%30 d: 2.7%In-hospital: 030 d: 10%NA8.8 ± 5OPTALYSE,16Tapson V.F. Sterling K. Jones N. et al.A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial.JACC Cardiovasc Intv. 2018; 11: 1401-1410https://doi.org/10.1016/j.jcin.2018.04.008Crossref PubMed Scopus (273) Google Scholar intermediate-risk, 2018 (n = 100)RCT comparing 4 USCDT regimens. Primary outcome: RV/LV ratio at 48 h30 d: 1%1 y: 2%72 h: 1%72 h: 4%NANAFLARE,17Tu T. Toma C. Tapson V.F. et al.A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study.JACC Cardiovasc Intv. 2019; 12: 859-869https://doi.org/10.1016/j.jcin.2018.12.022Crossref PubMed Scopus (265) Google Scholar intermediate-risk, 2019 (n = 106)Single-arm, multicenter study describing safety and efficacy of large-bore MT48 h: 0%48 h: 048 h: 0.9%NA4.1 ± 3.5EXTRACT-PE,18Sista A.K. Horowitz J.M. Tapson V.F. et al.Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial.JACC Cardiovasc Intv. 2021; 14: 319-329https://doi.org/10.1016/j.jcin.2020.09.053Crossref PubMed Scopus (133) Google Scholar intermediate-risk, 2021 (n = 119)Single-arm, multicenter study describing the outcomes of aspiration thrombectomy30 d: 2.5%48 h: 048 h: 1.7%48 h: 2.5%NASUNSET sPE,19Avgerinos E.D. Jaber W. Lacomis J. et al.Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial.JACC Cardiovasc Intv. 2021; 14: 1364-1373https://doi.org/10.1016/j.jcin.2021.04.049Crossref PubMed Scopus (67) Google Scholar intermediate-risk, 2021 (n = 81)RCT comparing USCDT vs. CDT. Primary outcome: clearance of pulmonary thrombus at 48 h48 hUSCDT: 2.5%CDT: 048 hUSCDT: 2.5%CDT: 048 hUSCDT: 5%CDT: 048 hUSCDT: 2.5%CDT: 0USCDT: 7.7 ± 8.7CDT: 4.6 ± 1.8Kroupa et al,20Kroupa J. Buk M. Weichet J. et al.A pilot randomised trial of catheter-directed thrombolysis or standard anticoagulation for patients with intermediate-high risk acute pulmonary embolism.EuroIntervention. 2022; 18: e639-e646https://doi.org/10.4244/EIJ-D-21-01080Crossref PubMed Scopus (12) Google Scholar intermediate-risk, 2022 (n = 81)RCT comparing CDT vs. heparin. Primary endpoint: improvement in RV function24 hCDT: 0Heparin: 024 hCDT: 0Heparin: 024 hCDT: 0Heparin: 0NACDT: 7.9 ± 2.7Heparin: 9.7 ± 4.1CANARY,21Sadeghipour P. Jenab Y. Moosavi J. et al.Catheter-directed thrombolysis vs anticoagulation in patients with acute intermediate-high-risk pulmonary embolism: the CANARY randomized clinical trial.JAMA Cardiol. 2022; 7: 1189-1197https://doi.org/10.1001/jamacardio.2022.3591Crossref PubMed Scopus (24) Google Scholar intermediate-risk, 2022 (n = 94)RCT comparing CDT vs. heparin. Primary endpoint: echocardiographic RV/LV ratio >0.9 at 90 d90 dCDT: 0Heparin: 6.5%90 dCDT: 0Heparin: 090 dCDT: 2.1%Heparin: 0NACDT: 6 (5-8)Heparin: 6 (5-8)FLASH,22Toma C. Jaber W.A. Weinberg M.D. et al.Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism.EuroIntervention. 2023; 18: 1201-1212https://doi.org/10.4244/EIJ-D-22-00732Crossref PubMed Scopus (30) Google Scholar intermediate and high-risk, 2023 (n = 800)Single-arm, multicenter study describing the outcomes with large-bore MT48 h: 0.3%30 d: 0.8%48 h: 048 h: 1.4%48 h: 0.25%3FLAME,23Silver M.J. Gibson C.M. Giri J. et al.Outcomes in high-risk pulmonary embolism patients undergoing FlowTriever mechanical thrombectomy or other contemporary therapies: results from the FLAME study.Circ Cardiovasc Interv. 2023; 16e013406https://doi.org/10.1161/CIRCINTERVENTIONS.123.013406Crossref PubMed Scopus (6) Google Scholar high-risk, 2023 (n = 115)Parallel-arm, multicenter nonrandomized study describing the outcomes with large-bore MT vs. other therapies (the study was nonrandomized and unadjusted)MT in-hospital: 1.9%MT in-hospital: 0MT in-hospital: 11.3%NA7 (3-12)Numbers expressed as %, mean ± SD, or median (IQR).CDT, catheter-directed thrombolysis; LV, left ventricle; MT, mechanical thrombectomy; NA, not available; RCT, randomized controlled trial; RV, right ventricle; USCDT, ultrasound-assisted catheter-directed thrombolysis. Open table in a new tab Numbers expressed as %, mean ± SD, or median (IQR). CDT, catheter-directed thrombolysis; LV, left ventricle; MT, mechanical thrombectomy; NA, not available; RCT, randomized controlled trial; RV, right ventricle; USCDT, ultrasound-assisted catheter-directed thrombolysis. Blood loss volume is a concern in thrombectomy procedures with a large-bore device; however, the levels of hemoglobin decrease found in REAL-PE are with with the T. Toma C. Tapson V.F. et al.A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study.JACC Cardiovasc Intv. 2019; 12: 859-869https://doi.org/10.1016/j.jcin.2018.12.022Crossref PubMed Scopus (265) Google C. Jaber W.A. Weinberg M.D. et al.Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism.EuroIntervention. 2023; 18: 1201-1212https://doi.org/10.4244/EIJ-D-22-00732Crossref PubMed Scopus (30) Google Scholar The blood loss in a recent studies between to A. Shafi I. Abdelrahman A. et al.Outcomes of catheter-based pulmonary artery embolectomy in patients with sub-massive to massive pulmonary embolism.Cureus. 2023; 15e34877https://doi.org/10.7759/cureus.34877Crossref PubMed Google Scholar,12Wible B.C. Buckley J.R. Cho K.H. Bunte M.C. Saucier N.A. Borsa J.J. Safety and efficacy of acute pulmonary embolism treated via large-bore aspiration mechanical thrombectomy using the Inari FlowTriever device.J Vasc Interv Radiol. 2019; 30: 1370-1375https://doi.org/10.1016/j.jvir.2019.05.024Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar a blood system was which be associated with lower blood In in assessing the between therapies and bleeding, or with ICH, the authors not report in the the findings for for of which may with or of other risk or would be helpful in multicenter comparative comparative studies can also include a cohort of patients with PE who are treated with anticoagulation as a of can complement the findings from and ongoing The of endovascular therapies for PE full of as compared to systemic thrombolysis has to be adequately the clinical that to be differences between the of these devices a but of however, there is a there is also an to there are ongoing and assessing the of endovascular therapies for PE to do at risk stratification for the risk or the current the results of the ongoing may patients to therapies from which they may the most D. Tapson et for acute pulmonary embolism and J 2023; PubMed Scopus (4) Google Scholar these high-quality of evidence the and improve is by a from the American Heart and was by the and and is by the Research from the for and at and and the Heart and from and that is a on of the for to 2 specific of has not been in the in 2022 or 2023 has in 2022 or is a of the for the American Thrombosis and in the Data Safety and of the trial by the and Blood and has to not specific from in the or
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Ortega-Paz et al. (2023) conducted an editorial in Pulmonary embolism (n=2,259). Mechanical thrombectomy (MT) vs. Ultrasound-assisted catheter-directed thrombolysis (USCDT) was evaluated on ISTH-modeled major bleeding (OR 1.37, 95% CI 1.10-1.74, p=<0.001). Mechanical thrombectomy for pulmonary embolism was associated with a higher risk of ISTH-modeled major bleeding compared to USCDT (15.4% vs 11.8%; OR 1.37; 95% CI 1.10-1.74; P<0.001).
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