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December 13, 2019Pulmonary CirculationOpen Access

Outcomes of catheter‐directed thrombolysis vs. standard medical therapy in patients with acute submassive pulmonary embolism

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Key result

Catheter-directed thrombolysis was associated with reduced 30-day (3.1% vs 6.1%) and 1-year (8.2% vs 18.2%) mortality compared to standard medical therapy in patients with submassive pulmonary embolism.

Why the study?

Although catheter-directed thrombolysis reduces right ventricle strain in submassive pulmonary embolism, its impact on clinical outcomes remains unclear.

Does catheter-directed thrombolysis reduce mortality compared to standard anticoagulation in patients with acute submassive pulmonary embolism?

Population

Consecutive patients admitted to an ICU with acute submassive pulmonary embolism

Comparison

Catheter-directed thrombolysis vs systemic anticoagulation

Design

Retrospective propensity-score matched observational study

Follow-up

1 year

Authors

SDStephen D’AuriaASAhmet SezerFTFloyd Thoma

Discussion

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Overview

May support consideration in submassive PE; leaves open need for randomized confirmation before practice change.

Key Points

  • To evaluate clinical outcomes and safety of catheter-directed thrombolysis compared with standard anticoagulation in intensive care unit patients presenting with acute submassive pulmonary embolism.
  • Retrospective observational study of consecutive patients with acute submassive pulmonary embolism admitted to an intensive care unit between June 2014 and April 2016.
  • Compared systemic anticoagulation (medical therapy) against catheter-based delivery of tissue plasminogen activator (CDL) using propensity-score matching based on the simplified pulmonary embolism severity index (sPESI).
  • Propensity-matched mortality rates were significantly lower with CDL versus medical therapy at 30 days (3.1% vs. 6.1%) and 1 year (8.2% vs. 18.2%), paralleling unadjusted rates (30-day: 3.0% vs. 10.4%; 1-year: 8.1% vs. 22.9%).
  • Hospital length of stay was significantly shorter in the CDL group, with no observed increase in index admission bleeding or transfusion rates.

Study Design

Type

Observational

Structured PICO

Does catheter-directed thrombolysis reduce mortality compared to standard anticoagulation in patients with acute submassive pulmonary embolism?

P
Population
Patients with acute submassive pulmonary embolism admitted to an intensive care unit, evaluated for 30-day and 1-year mortality.
E
Exposure
Catheter-based delivery of tissue plasminogen activator (tPA) (catheter-directed thrombolysis)
C
Comparator
Standard systemic anticoagulation (medical therapy)
O
Outcome
Mortality at 30 days and 1 yearhard clinical

Main Result

Absolute Event Rate: 3.1% vs 6.1%

Catheter-directed thrombolysis may reduce 30-day and 1-year mortality compared to standard anticoagulation in ICU patients with acute submassive pulmonary embolism without increasing bleeding risk.

Limitations

  • Retrospective observational design requiring confirmation by randomized studies
  • Retrospective observational design
  • Requires further randomized studies to confirm findings

Cite This Study

D’Auria et al. (2019) conducted an observational in Acute submassive pulmonary embolism. Catheter-directed thrombolysis (CDL) vs. Systemic anticoagulation (medical therapy) was evaluated on Mortality at 30 days (propensity-score matched). Catheter-directed thrombolysis was associated with reduced 30-day (3.1% vs 6.1%) and 1-year (8.2% vs 18.2%) mortality compared to standard medical therapy in patients with submassive pulmonary embolism.

synapsesocial.com/papers/6a8fa2dc418deb56e52bbd7chttps://doi.org/10.1177/2045894019898368
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Also Consider

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

  1. 1Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism2013 · 1,144 citations
  2. 2Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension2011 · 2,241 citations
  3. 3Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism*2018 · 77 citations
  4. 4N-Terminal Pro–Brain Natriuretic Peptide or Troponin Testing Followed by Echocardiography for Risk Stratification of Acute Pulmonary Embolism2005 · 305 citations
  5. 5Utilization of catheter‐directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter‐directed thrombolysis2015 · 101 citations