869: MORTALITY AND BLEEDING RISKS OF INTERVENTIONS FOR HIGH- AND INTERMEDIATE-RISK PULMONARY EMBOLISM

Abstract

Introduction: Multiple strategies have been used to treat patients at high and intermediate risk of mortality from an acute pulmonary embolism (PE), but the most effective and safest treatment remains poorly defined. We aimed to investigate the mortality and bleeding complications in high/intermediate risk PE patients following different treatments. Methods: We searched PubMed and EMBASE databases from inception to July 2022 and included observational studies and randomized controlled trials (RCT) encompassing high and intermediate risk PE patients and comparing at least two of the following treatments: systemic thrombolysis (ST), anticoagulation only (AC), catheter-directed intervention (CDI), and surgical embolectomy (SE). The primary outcome was in-hospital mortality. The secondary outcomes were 1-year mortality, major or minor bleeding. Results: This network meta-analysis identified four RCTs and 27 observational studies involving 117,628 patients. CDI was associated with lower in-hospital mortality than ST (OR [95%CI]: 0.42 [0.32-0.55]), AC (OR [95%CI]: 0.43 [0.27-0.66]), and SE (OR [95%CI]: 0.52 [0.33-0.82]). AC was associated with higher 1-year mortality than the other strategies. AC was associated with the lowest risk of major bleeding compared to ST (OR [95%CI]: 0.46 [0.29-0.74]), CDI (OR [95%CI]: 0.61 [0.38-0.99]), and SE (OR [95%CI]: 0.44 [0.23-0.85]). Furthermore, CDI was associated with lower risks of major bleeding than ST (OR [95%CI]: 0.75 [0.58-0.96]). AC was associated with lower risks of minor bleeding than ST and CDI, whereas CDI was also associated with a lower risk of minor bleeding compared to ST. Conclusions: In patients with high/intermediate risk PE, CDI was associated with lower mortality and decreased bleeding complications compared to other treatment strategies. Further studies including randomized control studies are required to validate our findings.