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Outcomes of Catheter Directed Therapy Plus Anticoagulation Versus Anticoagulation Alone for Submassive and Massive Pulmonary Embolism with Subgroup Analysis.
Am J Med. 2018 Oct 24;:
Authors: Hennemeyer C, Khan A, McGregor H, Moffett C, Woodhead G
Abstract
BACKGROUND: Catheter directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism.
METHODS: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over two years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8) or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed.
RESULTS: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (p<0.001) in the CDT group and from 1.40±0.37 to 1.25±0.32 (p=0.01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05±0.38 vs 1.20±0.31, p<0.001. In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the two treatment groups. Ninety-day mortality (11% and 14%, p=0.7) and incidence of major bleeding complications did not significantly differ between the groups. Thirty-day readmission rates were 8% in the CDT group and 26% in the anticoagulation group (p=0.04).
CONCLUSION: CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared to anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.
PMID: 30367851 [PubMed - as supplied by publisher]