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April 4, 2023Open Access

Impact of reperfusion therapies on clot resolution and long-term outcomes in patients with pulmonary embolism: a retrospective observational study

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Key result

Reperfusion therapies for acute pulmonary embolism resulted in a significantly greater absolute reduction in vascular obstructive index (45% vs 26%) and improved right ventricular function compared to anticoagulation alone.

Why the study?

Although reperfusion strategies have improved short-term outcomes in pulmonary embolism, up to 50% of patients report persistent dyspnea, leaving the impact on clot resolution and long-term outcomes compared with anticoagulation alone unclear.

Do reperfusion therapies improve clot resolution and long-term outcomes compared to anticoagulation alone in patients with acute pulmonary embolism?

Population

382 acute PE registry patients with repeat imaging at 3 to 12 months

Comparison

Reperfusion therapies followed by anticoagulation vs anticoagulation alone

Design

Single-center retrospective registry study

Follow-up

12 months

Authors

KLK.U. LioRBRiyaz BashirVLVladimir Lakhter

Discussion

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Member takes

Overview

Reperfusion therapies were associated with greater clot resolution in acute PE; hypothesis-generating and should not yet change practice.

Study Design

Type

Observational (n=382)

Multicenter

No

Structured PICO

Do reperfusion therapies improve clot resolution and long-term outcomes compared to anticoagulation alone in patients with acute pulmonary embolism?

P
Population
382 patients with acute pulmonary embolism who completed at least 3 months of anticoagulation and had repeat imaging for persistent dyspnea, followed for 3 to 12 months.
E
Exposure
Reperfusion therapies (including full-dose systemic thrombolysis, half-dose systemic thrombolysis, catheter-directed thrombolysis, and mechanical thrombectomy) followed by anticoagulation.
C
Comparator
Anticoagulation alone.
O
Outcome
Incidence of residual pulmonary vascular obstruction (RPVO) and clot burden (assessed by vascular obstructive index [VOI]) at 3 to 12 months following acute PE.surrogate

Main Result

Absolute Event Rate: 21% vs 9%

p-value: p=0.001

In patients with acute pulmonary embolism, reperfusion therapies were associated with greater clot resolution, improved right ventricular function, and lower 12-month mortality compared to anticoagulation alone.

Limitations

  • Did not include parameters representing exercise tolerance and functional capacity
  • Exclusion of patients with incomplete follow-up may have led to selection bias
  • Potential overestimation of RV dysfunction, PE recurrence, and CTEPH due to symptomatic patients being more likely to seek care
  • Relatively short mean follow-up time
  • Retrospective, single-center design
  • Did not include parameters that represent exercise tolerances and functional capacity
  • Patients with incomplete follow-up were excluded, which might have led to selection bias
  • Prevalence of RV dysfunction, PE recurrence, and CTEPH could have been overestimated as symptomatic patients were most likely to seek medical attention
  • Mean follow-up time is relatively short
  • Retrospective, single-center nature of the data

Cite This Study

Lio et al. (2023) conducted an observational in Acute pulmonary embolism (n=382). Reperfusion therapies vs. Anticoagulation alone was evaluated on Incidence of residual pulmonary vascular obstruction (RPVO) (p=0.001). Reperfusion therapies for acute pulmonary embolism resulted in a significantly greater absolute reduction in vascular obstructive index (45% vs 26%) and improved right ventricular function compared to anticoagulation alone.

synapsesocial.com/papers/6a980d69a9054fc672c61966https://doi.org/10.21203/rs.3.rs-2734365/v1
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Also Consider

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

  1. 1Impact of reperfusion therapies on clot resolution and long-term outcomes in patients with pulmonary embolism2024 · 8 citations
  2. 2Immediate and late impact of reperfusion therapies in acute pulmonary embolism2019 · 19 citations
  3. 3Reperfusion therapies in patients with intermediate- and high-risk pulmonary embolism: insights from a multicenter registry2024 · 3 citations
  4. 4Predictors of 90-Day Mortality and the Association of Reperfusion Therapy with 90-Day Mortality in Intermediate-High and High-Risk Pulmonary Embolism: A Real-World Multidisciplinary Cohort Study2026
  5. 5Reperfusion after pulmonary embolism - long-term follow-up, risk factors, clinical impact2018 · 6 citations