Key result
Catheter-based thrombectomy shows no benefit over catheter-directed thrombolysis for major events but less major bleeding.
Why the study?
The PEERLESS trial included few patients with thrombolysis contraindications, leaving uncertainty regarding how CDT performs relative to CBT in real-world acute PE patients with higher bleeding risk.
Does catheter-based thrombectomy reduce adverse clinical events compared to catheter-directed thrombolysis in patients with acute pulmonary embolism?
Cohort (n=162)
Yes
Does catheter-based thrombectomy reduce adverse clinical events compared to catheter-directed thrombolysis in patients with acute pulmonary embolism?
Hazard Ratio: 0.8 (95% CI 0.27–2.38)
Absolute Event Rate: 11.2% vs 15.2%
p-value: p=0.69
In a real-world acute pulmonary embolism cohort with higher bleeding risk, catheter-based thrombectomy reduced major bleeding and intracranial hemorrhage compared to catheter-directed thrombolysis without compromising efficacy.
Real-world CDT vs CBT data in higher-bleeding-risk PE may guide decisions; leaves open need for targeted RCTs.
BACKGROUND: The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk. AIMS: This study aims to address this gap by comparing real-world outcomes of CDT and CBT in patients with acute PE. METHODS: This retrospective analysis included patients who underwent CDT and CBT at two tertiary care centers from January 2020 to January 2024. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, or hemodynamic decompensation. Secondary outcomes included major bleeding and intracranial hemorrhage (ICH). Inverse probability treatment weighting (IPTW) was used to adjust for baseline variables. RESULTS: A total of 162 (mean age 58 years, 45.7% women, 17.3% high-risk, 28% contraindication to lytics, 28% CDT, 72% CBT) patients were included, with 12.4% patients experiencing the primary outcome. There was no difference in the rates of the primary outcome between CBT versus CDT (11.2% vs. 15.2%, IPTW HR: 0.80; 95% CI: 0.27-2.38, p = 0.69). CBT was associated with a lower risk of hemodynamic decompensation (5% vs. 21.7%, p = 0.036), major bleeding (7.8% vs. 17.4%, IPTW HR 0.26; 95% CI: 0.07-0.95, p = 0.042) and ICH (0 vs. 4.3%, p = 0.024) compared to CDT. CONCLUSION: Among a real-world cohort of patients with acute PE with higher bleeding risk than PEERLESS undergoing catheter-based therapies, CBT was associated with a lower rate of hemodynamic deterioration, major bleeding, and ICH with similar rate of primary composite outcome when compared with CDT. Additional randomized controlled trials are needed to validate these findings.
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Zhang et al. (2024) conducted a cohort in Acute pulmonary embolism (n=162). Catheter-based thrombectomy vs. Catheter-directed thrombolysis was evaluated on Composite of 30-day mortality, resuscitated cardiac arrest, or hemodynamic decompensation (HR 0.80, 95% CI 0.27-2.38, p=0.69). Catheter-based thrombectomy had similar rates of the primary composite outcome compared to catheter-directed thrombolysis (11.2% vs 15.2%; HR 0.80; P=0.69) but lower rates of major bleeding.
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