3:09 PM Abstract No. 256 Comparison of endovascular and noninvasive therapies in acute pulmonary embolism: a PERT experience

Abstract

Comparing the outcome measures and safety of endovascular therapy (EVT) with anticoagulation (AC) in the treatment of acute pulmonary embolism (PE) utilizing a Pulmonary Embolism Response Team (PERT). Retrospective review of medical records between January 2017 and August 2018 was performed to identify patients with acute massive or submassive PE who were evaluated by the PERT. Included were patients who received AC with or without EVT. Excluded were patients who were treated with IVC filter only. Analysis was performed comparing patients who received AC alone and those who received AC and EVT. A subgroup analysis was performed for patients who were initially admitted to the ICU comparing AC with or without EVT. A total of 207 patients were identified, 4 were excluded as they did not receive AC and were treated only with IVC filters. There were 153 patients in the AC group and 50 in the EVT group. The AC group was significantly older (64.7 ± 16.4 vs. 58.2 ± 16.2 years, P = 0.02) and had a shorter ICU stay (0.97 ± 2.6 vs. 1.4 ± 1.5 days, P <0.001), although only 35.9% (n = 55) of the AC group were admitted to the ICU (compared to 70% (n = 35) in the EVT group, P <0.001). The rate for initial admission to a stepdown unit was 45.8% for the AC group and 16% for the EVT group (P <0.001). There was a 7.2% major hemorrhagic complication rate in the AC group and 6% in the EVT group (P = 1). The minor hemorrhagic complication rate was 1.3% for the AC group and 0% for the EVT (P = 1). When comparing patients who were initially admitted to the ICU, age (61.7 ± 16.7 vs. 57.7 ± 16.9 years, P = 0.2) and ICU stay (2 ± 2.2 vs. 1.9 ± 1.5 days, P = 0.15) were not significantly different between the AC and EVT groups, respectively. The total hospital stay for the AC group in the subgroup analysis was 7.7 ± 10.2 days while the EVT group stay was 6.3 ± 7.4 (P = 0.2). For patients evaluated by the PERT, major hemorrhagic complication rates were not significantly different between AC and EVT, and for patients initially admitted to the ICU, the ICU length of stay was not significantly different.