Abstract 15283: Thrombolysis (Catheter Directed/ Systemic) in Pulmonary Embolism: Predictors and Etiologies of Readmissions
Background: Thrombolytic therapy (systemic (ST) or Cather Directed (CDT)) leads to early hemodynamic improvement in pulmonary embolism (PE) but it is unclear whether this beneficial effect persists. Limited data is available on risk of recurrent thromboembolism and bleeding on hospital discharge and its implications on hospital readmissions.
Methods: The study cohort was derived from the HCUP’s National Readmission Data (NRD) 2013, sponsored by AHRQ. PE was identified by ICD 9 CM diagnosis code (415.11/12/19) in primary diagnosis filed. Readmission was defined as a subsequent hospital admission within 30 days following an index admission. The propensity score matching was used to eliminate the confounders including but not limited to age, gender, comorbidities and hospital teaching status. Hierarchical two level logistic models were used to evaluate study outcomes.
Results: During the study year, of 2060 pts admitted with PE, 591 (28.69%) were treated with CDT and 1469 (71.31%) with ST. Out of this, 164 pts (7.92%) were readmitted within 30 days. The propensity score matched comparison revealed similar readmissions in CDT group compared to ST group (7.79 % vs. 8.71%, p=NS). Odds ratio for readmissions in CDT group by multivariate analysis showed similar trend (OR 0.80, 95% CI 0.59 - 1.09, p=NS). Amongst the etiologies of readmission, ST showed increased trends towards readmission secondary to bleeding complications (14.2% vs. 7.9%, p = NS), while decreased trends towards readmission secondary to hypercoagulable state (20% vs. 23.7%, p = NS) (fig 1). Significant predictors of 30 day readmissions included Age group 35-49 yrs, renal failure, anemia/ coagulopathy (fig 2).
Conclusion: There is trend towards higher bleeding with ST and higher hypercoagulable state related readmissions with CDT. Large scale trials are needed to further confirm these findings which in turn may help transitioning care to outpatient settings for these patients.
Author Disclosures: P. Patel: None. S. Arora: None. S. Lahewala: None. P. Shah: None. N.V. Patel: None. V. Patel: None. H. Shah: None. B. Tripathi: None. C. Bambhroliya: None. S. Patel: None. S. Panaich: None. A. Deshmukh: None. A. Badheka: None.
- © 2016 by American Heart Association, Inc.