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April 27, 2020Vascular MedicineOpen Access

Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims

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Key result

Catheter-directed thrombolysis for pulmonary embolism was associated with lower in-hospital mortality (6.5% vs 10.0%, p=0.02) and higher all-cause bleeding (15.9% vs 8.7%) than systemic thrombolysis.

Why the study?

Catheter-directed thrombolysis and systemic thrombolysis are used to treat intermediate/high-risk pulmonary embolism despite a lack of comparative safety and effectiveness data.

Does catheter-directed thrombolysis improve mortality and bleeding outcomes compared to systemic thrombolysis in patients with pulmonary embolism?

Population

1915 patients receiving CDT or ST among 100,744 patients hospitalized with PE

Comparison

Catheter-directed thrombolysis vs systemic thrombolysis

Design

Retrospective propensity score-matched administrative claims database study

Authors

BGBram J. GellerSASrinath AdusumalliSPSteven C. Pugliese

Discussion

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Overview

CDT was associated with lower mortality but higher bleeding than ST in PE; leaves open need for RCTs to guide selection.

Key Points

  • The aim is to evaluate the safety and effectiveness of catheter-directed thrombolysis compared to systemic thrombolysis in treating pulmonary embolism.
  • Utilized the Optum ® Clinformatics ® Data Mart to analyze claims from 100,744 patients with pulmonary embolism from 2004 to 2014.
  • Extracted demographic data, comorbidities, and outcomes related to treatment methods.
  • Used propensity score matching to compare outcomes of 632 patients receiving catheter-directed thrombolysis and 1283 patients receiving systemic thrombolysis.
  • Intracranial hemorrhage rates were similar in both groups at 1.9% (p = 1.0).
  • CDT group experienced higher all-cause bleeding at 15.9% compared to 8.7% in the ST group (p < 0.001).
  • In-hospital mortality was lower in the CDT group at 6.5% compared to 10.0% in the ST group (p = 0.02).

Study Design

Type

Cohort (n=1,915)

Multicenter

Yes

Structured PICO

Does catheter-directed thrombolysis improve mortality and bleeding outcomes compared to systemic thrombolysis in patients with pulmonary embolism?

P
Population
1,915 patients hospitalized with pulmonary embolism who received either catheter-directed or systemic thrombolysis, evaluated using a national administrative claims database.
E
Exposure
Catheter-directed thrombolysis (CDT)
C
Comparator
Systemic thrombolysis (ST)
O
Outcome
Intracranial hemorrhage (ICH), all-cause bleeding, and in-hospital mortalityhard clinical

Main Result

Absolute Event Rate: 6.5% vs 10%

p-value: p=0.02

In a real-world cohort of patients with pulmonary embolism, catheter-directed thrombolysis was associated with lower in-hospital mortality but higher all-cause bleeding compared to systemic thrombolysis.

Limitations

  • Lack of randomized comparative safety and effectiveness data

Cite This Study

Geller et al. (2020) conducted a cohort in Pulmonary embolism (n=1,915). Catheter-directed thrombolysis vs. Systemic thrombolysis was evaluated on In-hospital mortality (p=0.02). Catheter-directed thrombolysis for pulmonary embolism was associated with lower in-hospital mortality (6.5% vs 10.0%, p=0.02) and higher all-cause bleeding (15.9% vs 8.7%) than systemic thrombolysis.

synapsesocial.com/papers/6a5da1f7a170fefb8e8a586dhttps://doi.org/10.1177/1358863x20903371
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a meta-analysis2023 · 5 citations
  2. 2Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients2022 · 36 citations
  3. 3Midterm Prognosis of Patients With Pulmonary Embolism Receiving Catheter‐Directed Thrombolysis or Systemic Thrombolysis: A Nationwide Population‐Based Study2021 · 12 citations
  4. 4C23-22 Catheter Directed Thrombolysis Versus Systemic Therapy in Pulmonary Embolism: A Decade of Experience From the National Inpatient Sample (2010-2021)2026
  5. 5Outcomes with catheter-directed thrombolysis vs. catheter-directed embolectomy among patients with high-risk pulmonary embolism: a nationwide analysis2023 · 23 citations