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Catheter-directed thrombolysis for pulmonary embolism lowers in-hospital mortality
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Compared with systemic thrombolysis, catheter-directed thrombolysis reduced in-hospital mortality and a composite endpoint of in-hospital mortality and intracranial hemorrhage among patients with pulmonary embolism.
The study, which was published in Catheterization and Cardiovascular Interventions, included data culled from the Nationwide Inpatient Sample from 2010 to 2012 using ICD-9-CM diagnostic codes for acute pulmonary embolism. The primary endpoint was in-hospital mortality, and the secondary endpoint was combined in-hospital mortality and intracranial hemorrhage.
Overall, 110,731 patients were hospitalized with pulmonary embolism during the evaluated period. Researchers reported that 1,521 of these patients were treated with thrombolysis, of whom 1,169 received systemic thrombolysis and 352 received catheter-directed thrombolysis.
Patients who received catheter-directed thrombolysis had lower rates of both the primary (13.36% vs. 21.81%; OR = 0.55; 95% CI, 0.36-0.85) and secondary (13.36% vs. 22.89%; OR = 0.52; 95% CI, 0.34-0.8) endpoints.
Median length of stay was comparable between the two groups (P = .17), whereas patients in the catheter-directed thrombolysis group experienced a higher hospitalization cost ($23,799 vs. $17,218; P < .001).
Independent predictors of in-hospital mortality included increasing age (OR = 1.02; 95% CI, 1.01-1.04), cardiopulmonary arrest (OR = 13.01; 95% CI, 8.01-21.12), Medicaid insurance (OR = 2.23; 95% CI, 1.01-4.94 compared with Medicare insurance) and saddle pulmonary embolism (OR = 2.75; 95% CI, 1.76-4.3) according to results from multivariate analysis.
The researchers also observed an increase in the utilization of catheter-directed thrombolysis during the study period.
“A randomized controlled trial with outcomes such as mortality, [intracranial hemorrhage] and chronic thromboembolic pulmonary hypertension is needed to definitively address the comparative effectiveness between these two strategies,” the researchers wrote. – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.
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