Abstract 10720: Outcomes of Ultrasound Assisted Catheter Directed Thrombolysis Compared to Anticoagulation Alone in Patients with Intermediate Risk Pulmonary Embolism: A Meta-Analysis

Abstract

Purpose: USCDT is evolving as a popular treatment for PE. Studies have shown that USCDT causes significant reduction in RV strain and pulmonary hypertension risk. However, impact of these treatment modalities on clinical outcomes remains unclear. We conducted meta-analysis of observational studies to assess safety and mortality outcomes of USCDT compared with systemic anticoagulation alone in patients with submassive PE. Methods: Systematic literature search was performed using PUBMED database. Studies published from January 2008-December 2020 were identified using search terms “catheter thrombolysis” and “pulmonary embolism”. Outcomes included mortality and bleeding. Meta-analysis was performed using Review-Manager version-5.4. Effect size was measured using random effects with 95%-confidence interval. Results: 5 retrospective observational studies with 985 patients were included. Meta-analysis was performed for both mortality and major bleeding outcomes. Mortality rate was significantly greater in the anticoagulation group as compared to the USCDT group (odds ratio=3.08, 95%CI 1.62-5.87). There was no statistically significant difference in major bleeding rates between anticoagulation and USCDT groups (Risk-ratio=0.68, 95%CI 0.25-1.83). Heterogeneity was not significant among the five studies for mortality or bleeding outcome (I 2 =0%, p=0.82; I 2 =18%, p=0.30, respectively). Conclusions: USCDT, in addition to its known therapeutic efficacy, is associated with better mortality outcomes and no significant difference in major bleeding risk when compared to systemic anticoagulation. Clinical Implications: USCDT can be utilized over systemic anticoagulation alone in patients presenting with submassive PE for better outcomes.