Author + information
- Jeffrey Fowler1,
- Stephen D'Auria2,
- Andrew Althouse2,
- Jeffrey McKibben2,
- Belinda Rivera-Lebron2,
- Efthimios Avgerinos2 and
- Catalin Toma2
Catheter-directed thrombolysis (CDT) for acute pulmonary embolism (PE) has emerged as an alternative to systemic thrombolysis (ST) in patients with massive and submassive PE. ST in patients with submassive PE is effective at reducing PE related morbidity compared to heparin alone, however the net clinical event is negative due to excessive bleeding. It remains unclear how does CDT compares to ST.
We compared clinical outcomes and major bleeding between CDT and ST in patients presenting with acute massive and submassive PE at our institution between Jan 2006 to Oct 2015. End-points were mortality, bleeding requiring transfusion and intracerebral hemorrhage during index hospitalization, and readmission rates.
From 2006-2015, 268 patients with PE were reviewed, with a mean age 58 ± 16 years, and 46% male. 91 patients presented with massive PE (73 receiving ST vs 18 receiving CDT) and 177 with submassive PE (28 receiving ST vs 149 receiving CDT). CDT was performed with EKOS system® (Ekos Corp, Bothell, WA) in 98 cases and with multihole catheter in 69 patients. Mortality in both treatment arms was comparable when stratified by massive PE (42% in ST vs 50% in CDT, p=0.5) vs submassive PE (12% in ST vs 11% in CDT, p=0.9), during a median follow-up time of 24 months (Figure 1). Bleeding requiring transfusion during the index hospitalization was significantly higher in patients treated with ST vs CDT, (33.7% vs 13.2%, p<0.001). Intracerebral hemorrhage was slightly higher in ST vs CDT (3.0% vs 0.6%, p=0.12). Readmission for any cause at 1 year was high and comparable in ST vs CDT (42.9% vs 37.6%, p=0.173).
When compared to ST, CDT has similar outcomes with reduced rates of major bleeding and may be the preferred approach in patients who can be stabilized hemodynamically.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention