Abstract 15240: Catheter-Directed Thrombolysis versus Systemic Thrombolysis in Pulmonary Embolism: Predictors of In-Hospital Mortality and Major Bleeding
Introduction: In acute pulmonary embolism (PE), systemic thrombolysis(ST) therapy leads to early hemodynamic improvement, but associated with major bleeding, and is withheld in many patients at risk. Whether catheter directed thrombolysis(CDT) is superior to systemic thrombolysis in high risk PE patients is still unclear.
Methods: The study cohort was derived from the HCUP’s National Readmission Data (NRD) 2013, sponsored by the AHRQ. PE was identified by ICD 9 CM code-415.11/13/19 in primary diagnosis filed. ST and CDT were identified appropriate ICD 9 codes in primary or secondary procedural field. The primary outcome was in hospital mortality and secondary outcome was in hospital mortality and/or major bleeding events [Intra cranial hemorrhage(ICH) + Gastrointestinal Bleed (GI bleed)]. The propensity score match (1:2) and hierarchical two level logistic model were used to adjust confounders mentioned in table.
Results: 2060 PE patients were treated with thrombolytic, of which 591 (28.69%) were treated with CDT and 1469 (71.31%) with ST. After adjusting for propensity score match method, there was no difference in baseline characteristics but low primary outcome (7.99% vs. 15.47%, p < 0.001) and low secondary outcomes (7.99% vs 15.47%, <0.001) were observed with CDT as compared to ST. similar results were observed with hierarchical multivariate method (OR, 95 % CI, p value) (Primary:0.45, 0.31- 0.66, p<0.001) and (secondary: 0.54, 0.39-0.76, p<0.001). Discharge to facility (9.22 vs. 14.45, <0.001) was lower with CDT vs. ST in propensity match cohort. ICH, GI bleed, blood transfusion and length of stay were not statistically significant after adjusting for propensity score match.
Conclusions: In Pulmonary Embolism treatment, use of CDT is superior compared to systemic thrombolysis in terms of in hospital mortality and major bleeding complications. Further large scale randomized trials are required to further assess the effectiveness of CDT.
Author Disclosures: S. Arora: None. S. Lahewala: None. P. Patel: None. H. Shah: None. N. Patel: None. P. Shah: None. S. Patel: None. C. Bambhroliya: None. K. Dhaduk: None. C. Savani: None. B. Tripathi: None. N. Patel: None. S. Panaich: None. A. Deshmukh: None. A. Badheka: None.
- © 2016 by American Heart Association, Inc.