What question did this study set out to answer?

To evaluate patient characteristics and the impact of catheter-directed thrombolysis versus anticoagulation alone on residual systolic pulmonary artery pressure in intermediate-high-risk pulmonary embolism.

January 1, 2021Eurasian Journal of PulmonologyOpen Access

Comparison of catheter-directed thrombolysis and anticoagulation in intermediate-risk pulmonary embolism: A retrospective analysis

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Why the study?

The selection of escalation of care strategies for treating intermediate-risk pulmonary embolism remains a matter of debate.

Does catheter-directed thrombolysis reduce discharge systolic pulmonary artery pressure compared to anticoagulation alone in patients with intermediate-high-risk pulmonary embolism?

Population

30 intermediate-high-risk PE patients

Comparison

Catheter-directed thrombolysis vs anticoagulation alone

Design

Retrospective study

Follow-up

To discharge

Authors

DODeryaOzden OmaygencSağlık Bilimleri Üniversitesi MOMehmetOnur OmaygencIstanbul Medipol University

Discussion

Member takes

Implication

Lower discharge sPAP with CDT in selected patients; leaves open whether CDT improves outcomes versus anticoagulation in intermediate-high-risk PE.

Key Points

To evaluate patient characteristics and the impact of catheter-directed thrombolysis versus anticoagulation alone on residual systolic pulmonary artery pressure in intermediate-high-risk pulmonary embolism.
Retrospective analysis of 30 patients with intermediate-high-risk pulmonary embolism treated with either anticoagulation alone using twice-daily enoxaparin (n = 16) or catheter-directed thrombolysis (n = 14).
Catheter-directed thrombolysis protocol comprised a 5 mg bolus of alteplase followed by a continuous infusion of 1 mg/h over 24 hours.
Estimated systolic pulmonary artery pressure (sPAP) was recorded at presentation and discharge, with sPAP ≥ 40 mmHg at discharge defined as a significant residual elevation.
Discharge sPAP was significantly lower in the catheter-directed thrombolysis group than in the anticoagulation group (33.6 ± 9.7 mmHg vs. 42 ± 11.2 mmHg, P = 0.04), accompanied by a significantly greater reduction in pressure from baseline.
Catheter-directed thrombolysis was selected more frequently in patients with lower baseline bleeding risk, evidenced by lower HAS-BLED scores (1 [0–3] vs. 2 [0–3], P = 0.03).
High residual sPAP (≥ 40 mmHg) at discharge was significantly associated with higher baseline sPAP (67.3 ± 11.3 mmHg vs. 56.6 ± 13.1 mmHg, P = 0.02) and higher baseline HAS-BLED scores (2 [0–3] vs. 1 [0–3], P = 0.02).

Structured PICO

Does catheter-directed thrombolysis reduce discharge systolic pulmonary artery pressure compared to anticoagulation alone in patients with intermediate-high-risk pulmonary embolism?

Population

30 patients with intermediate-high-risk pulmonary embolism

Intervention

Catheter-directed thrombolysis (CDT) with alteplase (5 mg bolus followed by 1 mg/h infusion for 24 h)

Comparator

Anticoagulation alone with enoxaparin (b.i.d injections)

Outcome

Estimated systolic pulmonary artery pressure (sPAP) at dischargesurrogate

In a retrospective cohort of intermediate-high-risk PE patients, catheter-directed thrombolysis was associated with lower discharge sPAP compared to anticoagulation alone, though it was selected for patients with lower baseline bleeding risk.

Cite This Study

Omaygenc et al. (2021) studied this question.

synapsesocial.com/papers/6a8bdf493fd21775a533c1e6 https://doi.org/10.4103/ejop.ejop_73_20

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January 1, 2021Eurasian Journal of PulmonologyOpen Access

Comparison of catheter-directed thrombolysis and anticoagulation in intermediate-risk pulmonary embolism: A retrospective analysis

View Full Paper

Ask AI

Bookmark

Why the study?

The selection of escalation of care strategies for treating intermediate-risk pulmonary embolism remains a matter of debate.

Does catheter-directed thrombolysis reduce discharge systolic pulmonary artery pressure compared to anticoagulation alone in patients with intermediate-high-risk pulmonary embolism?

Population

30 intermediate-high-risk PE patients

Comparison

Catheter-directed thrombolysis vs anticoagulation alone

Design

Retrospective study

Follow-up

To discharge

Authors

DODeryaOzden OmaygencSağlık Bilimleri Üniversitesi MOMehmetOnur OmaygencIstanbul Medipol University

Discussion

Member takes

Implication

Lower discharge sPAP with CDT in selected patients; leaves open whether CDT improves outcomes versus anticoagulation in intermediate-high-risk PE.

Key Points

To evaluate patient characteristics and the impact of catheter-directed thrombolysis versus anticoagulation alone on residual systolic pulmonary artery pressure in intermediate-high-risk pulmonary embolism.
Retrospective analysis of 30 patients with intermediate-high-risk pulmonary embolism treated with either anticoagulation alone using twice-daily enoxaparin (n = 16) or catheter-directed thrombolysis (n = 14).
Catheter-directed thrombolysis protocol comprised a 5 mg bolus of alteplase followed by a continuous infusion of 1 mg/h over 24 hours.
Estimated systolic pulmonary artery pressure (sPAP) was recorded at presentation and discharge, with sPAP ≥ 40 mmHg at discharge defined as a significant residual elevation.
Discharge sPAP was significantly lower in the catheter-directed thrombolysis group than in the anticoagulation group (33.6 ± 9.7 mmHg vs. 42 ± 11.2 mmHg, P = 0.04), accompanied by a significantly greater reduction in pressure from baseline.
Catheter-directed thrombolysis was selected more frequently in patients with lower baseline bleeding risk, evidenced by lower HAS-BLED scores (1 [0–3] vs. 2 [0–3], P = 0.03).
High residual sPAP (≥ 40 mmHg) at discharge was significantly associated with higher baseline sPAP (67.3 ± 11.3 mmHg vs. 56.6 ± 13.1 mmHg, P = 0.02) and higher baseline HAS-BLED scores (2 [0–3] vs. 1 [0–3], P = 0.02).

Structured PICO

Does catheter-directed thrombolysis reduce discharge systolic pulmonary artery pressure compared to anticoagulation alone in patients with intermediate-high-risk pulmonary embolism?

Population

30 patients with intermediate-high-risk pulmonary embolism

Intervention

Catheter-directed thrombolysis (CDT) with alteplase (5 mg bolus followed by 1 mg/h infusion for 24 h)

Comparator

Anticoagulation alone with enoxaparin (b.i.d injections)

Outcome

Estimated systolic pulmonary artery pressure (sPAP) at dischargesurrogate

Cite This Study

Omaygenc et al. (2021) studied this question.

synapsesocial.com/papers/6a8bdf493fd21775a533c1e6 https://doi.org/10.4103/ejop.ejop_73_20

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