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Catheter-directed Thrombolysis for Intermediate-Risk Pulmonary Embolism
David Furfaro1, R Scott Stephens2, Michael B Streiff3
11 Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, Columbia University, New York, New York.
Annals of the American Thoracic Society
|October 27, 2017
Summary
Catheter-directed thrombolysis offers faster symptom relief for intermediate-risk pulmonary embolism than anticoagulation alone. However, current evidence does not support its superiority in reducing mortality or preventing chronic outcomes, necessitating further research.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Interventional Radiology
Background:
- Intermediate-risk pulmonary embolism (PE) is a common condition with potential for severe outcomes.
- Catheter-directed thrombolysis (CDT) is increasingly used, assuming greater efficacy and safety than other treatments.
- Critical analysis of existing data on CDT for intermediate-risk PE is warranted.
Purpose of the Study:
- To critically evaluate the efficacy and safety of catheter-directed thrombolysis for intermediate-risk pulmonary embolism.
- To compare CDT with anticoagulation alone and systemic thrombolysis.
- To assess the impact of CDT on mortality, right heart strain, and chronic thromboembolic pulmonary hypertension (CTEPH).
Main Methods:
- Systematic review and critical analysis of published literature on catheter-directed thrombolysis for intermediate-risk PE.
- Comparison of outcomes including mortality, hemodynamic parameters, procedural complications, and bleeding risk.
- Evaluation of evidence regarding ultrasound-assisted thrombolysis.
Main Results:
- CDT rapidly reduces right heart strain and pulmonary artery pressures compared to anticoagulation alone.
- Mortality rates for CDT (0-4%) are similar to anticoagulation alone.
- CDT appears safer than systemic thrombolysis, with low procedural complication rates but a slightly higher bleeding risk than anticoagulation alone.
- No evidence supports CDT's efficacy in preventing CTE chronic thromboembolic pulmonary hypertension.
- Ultrasound-assisted thrombolysis shows no proven benefit over standard CDT.
Conclusions:
- While CDT offers faster hemodynamic improvement for intermediate-risk PE, its mortality benefit over anticoagulation alone is not established.
- CDT is safer than systemic thrombolysis but carries a slightly increased bleeding risk.
- Randomized controlled trials are essential to definitively compare CDT and anticoagulation.
- Current evidence does not support CDT for preventing chronic thromboembolic pulmonary hypertension.
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