C-34 | Impact of Timing of Catheter-Directed Thrombolysis in Pulmonary Embolism on In-Hospital Outcomes

Abstract

Catheter-Directed Thrombolysis (CDT) has emerged as an acceptable and safe modality in the treatment of intermediate to high-risk pulmonary embolism (PE). It is currently unknown whether in-hospital outcomes are affected by early (<48 hours) versus late (>48 hours) initiation of CDT from time of admission of patients with PE. The National Inpatient Sample database was queried from the years 2016-2019 to obtain our sample of PE admissions using appropriate ICD-10-CM codes. Those with concurrent acute limb ischemia, ischemic stroke, stenting or bypass procedures in the same admission were excluded. Our cohort was divided into those who underwent early or late intervention with CDT. Outcomes were measured using multivariate logistic regression and propensity score matching to obtain adjusted odds ratios (aOR). 27,435 patients received CDT, of which 22,650 underwent early intervention and 3,935 underwent late intervention. After propensity score matching, no differences in the likelihood of mortality (aOR 0.84, p=0.194) and vasopressor use (aOR 1.04, p=0.863) were found between the two interventions. The late intervention group had higher likelihood of concurrent need for systemic thrombolysis (aOR 1.66, p<0.01), blood transfusions (aOR 1.36, p<0.01), and intubation (aOR 1.31, p=0.01). Delaying CDT in patients with intermediate to high-risk PE led to a greater need for systemic thrombolysis, blood transfusion, and mechanical ventilation but did not lead to increase in-hospital mortality. Future randomized clinical trials should focus on the timing of CDT in PE to further elucidate its effects.