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Prehospital Thrombolysis: A Manual from Berlin
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Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic

Nish Patel1, Nileshkumar J Patel2, Kanishk Agnihotri3

  • 1Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 27, 2015
PubMed

Insights

Catheter-directed thrombolysis (CDT) significantly reduced in-hospital mortality and intracranial hemorrhage compared to systemic thrombolysis for acute pulmonary embolism (PE). This study highlights CDT as a safer and more effective treatment option for PE patients.

Area of Science:

  • Cardiology
  • Pulmonology
  • Interventional Radiology

Background:

  • Real-world data comparing systemic thrombolysis and catheter-directed thrombolysis (CDT) for acute pulmonary embolism (PE) is limited.
  • Understanding the comparative effectiveness and utilization of these treatments is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate the utilization of CDT versus systemic thrombolysis in acute PE patients.
  • To compare the in-hospital mortality and complication rates between CDT and systemic thrombolysis.

Main Methods:

  • A retrospective analysis of the Nationwide Inpatient Sample (2010-2012) was conducted for acute PE patients.
  • Propensity score analysis was employed to compare outcomes between patients receiving systemic thrombolysis and CDT.
  • In-hospital mortality and the combined outcome of mortality and intracranial hemorrhage (ICH) were primary and secondary endpoints, respectively.

Main Results:

  • Out of 1,521 patients treated with thrombolysis for PE, 352 received CDT and 1,169 received systemic thrombolysis.
  • After propensity score matching, CDT demonstrated significantly lower in-hospital mortality (13.36% vs. 21.81%) and combined mortality/ICH (13.36% vs. 22.89%) compared to systemic thrombolysis.
  • While length of stay was similar, CDT was associated with higher hospitalization costs ($17,218 vs. $23,799).

Conclusions:

  • Catheter-directed thrombolysis is associated with reduced in-hospital mortality and fewer intracranial hemorrhages in acute PE patients.
  • CDT represents a potentially safer alternative to systemic thrombolysis for selected PE cases.
  • Further research may explore cost-effectiveness and long-term outcomes of CDT in PE management.
Abstract

Keywords:
CDTfibrinolysishospitalizationoutcomes researchperipheral interventionspulmonary embolismthrombolysistrendsvenous thromboembolism

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