Catheter-Directed Thrombolysis in Submassive Pulmonary Embolism and Acute Cor Pulmonale

Treatment of submassive (intermediate-risk) pulmonary embolism (PE), defined as hemodynamically stable with right ventricular (RV) dysfunction, showed lower in-hospital all-cause mortality with intravenous thrombolytic therapy than with anticoagulants, but at an increased risk of major bleeding. The...

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Bibliographic Details
Published in:The American journal of cardiology 2020-09, Vol.131, p.109-114
Main Authors: Stein, Paul D., Matta, Fadi, Hughes, Mary J.
Format: Article
Language:English
Subjects:
Anticoagulants
Bleeding
Catheters
Cor pulmonale
Drug dosages
Embolism
Fatalities
Heart
Intravenous administration
Medical instruments
Mortality
Patients
Pulmonary embolisms
Software
Thromboembolism
Thrombolysis
Time dependent analysis
Ultrasonic imaging
Ventricle
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Summary:Treatment of submassive (intermediate-risk) pulmonary embolism (PE), defined as hemodynamically stable with right ventricular (RV) dysfunction, showed lower in-hospital all-cause mortality with intravenous thrombolytic therapy than with anticoagulants, but at an increased risk of major bleeding. The present investigation was performed to test whether catheter-directed thrombolysis reduces mortality without increasing bleeding in submassive PE. This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample. In 2016, 13,130 patients were hospitalized with PE and acute cor pulmonale, were stable, and treated with catheter-directed thrombolysis in 1,500 (11%) or anticoagulants alone in 11,630 (89%). Mortality was lower with catheter-directed thrombolysis than with anticoagulants in unmatched patients, 35 of 1,500 (2.3%) compared with 755 of 11,630 (6.5%; p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2020.06.048