Abstract
Background
Although systemic thrombolysis (ST) or catheter-directed therapy (CDT) is performed
in patients with acute massive or submassive pulmonary embolism (PE), clinical data
comparing between both therapies remain limited. We compared clinical outcomes between
ST and CDT in patients with acute massive and submassive PE.
Methods
From January 2005 to June 2015, clinical outcomes of patients with acute massive or
submassive PE receiving ST or CDT were evaluated and compared retrospectively.
Results
Of 72 patients, 44 were treated with ST; and 28, with CDT. The mean age was 63.9 ±
17 years old. The proportion of male sex was higher in patients receiving CDT compared
to that with ST (46.4% vs 20.5%; P = .02). Half of patients presented with massive PE, and cardiac arrest occurred in
11 patients (15.3%). No difference was observed between the 2 groups with respect
to 7-day mortality (13.6% in ST vs 10.7% in CDT), inhospital mortality (13.6% in ST
vs 14.3% in CDT), and major bleeding complication (16.7% in ST vs 16.7% in CDT). Cardiac
arrest (odds ratio, 6.286; 95% confidence interval, 1.081-36.555; P = .041) was associated with 14-day mortality.
Conclusions
Similar clinical outcomes were shown between ST and CDT in patients with acute massive
or submassive PE.
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References
- Massive pulmonary embolism.Circulation. 2006; 113: 577-582
- Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.Circulation. 2008; 117: 1711-1716
- Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction.Circulation. 2000; 101: 2817-2822
- Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis.JAMA. 2014; 311: 2414-2421
- Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis.Eur Heart J. 2015; 36: 605-614
- Management Strategies And Prognosis Of Pulmonary Embolism-3 Trial Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism.N Engl J Med. 2002; 347: 1143-1150
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N Engl J Med. 2014; 370: 1402-1411
- Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association.Circulation. 2011; 123: 1788-1830
- Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e419S-e494S
- Catheter directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques.J Vasc Interv Radiol. 2009; 20: 1431-1440
- Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism.Circulation. 2014; 129: 479-486
- Catheter directed thrombolytic intervention is effective for patients with massive and submassive pulmonary embolism.Ann Vasc Surg. 2014; 28: 1589-1594
- Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis.Eur Respir J. 2014; 43: 1678-1690
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost. 2005; 3: 692-694
- Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).Lancet. 1999; 353: 1386-1389
- The role of thrombolytic therapy in pulmonary embolism.Blood. 2015; 125: 2191-2199
- Catheter directed embolectomy, fragmentation, and thrombolysis for the treatment of massive pulmonary embolism after failure of systemic thrombolysis.Chest. 2008; 134: 250-254
- Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): initial results from a prospective multicenter registry.Chest. 2015; 148: 667-673
- Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis.Catheter Cardiovasc Interv. 2015; 86: 1219-1227
Article Info
Publication History
Published online: February 15, 2016
Accepted:
February 12,
2016
Received in revised form:
February 12,
2016
Received:
December 28,
2015
Footnotes
☆All authors declared that they had no conflicts of interest.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
