C-36 | Comparison of Systemic Thrombolysis and Mechanical Thrombectomy in COVID-19–Related Pulmonary Embolism

Abstract

Pulmonary embolism (PE) is a complication that can occur in individuals with COVID-19 because of the inherent thrombogenic risk. Systemic thrombolysis and mechanical thrombectomy are treatment modalities employed for PE with hemodynamic instability. Data were extracted from the National Inpatient Sample (NIS) 2020 Database. The NIS was searched for hospitalizations for PE and co-existing COVID infection. Systemic thrombolysis and mechanical thrombectomy were identified using appropriate ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are shown in Figure 1. Multivariable logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Of 46,965 patients with PE related to COVID, 1260 received systemic thrombolysis, and 320 had mechanical thrombectomy. The mechanical thrombectomy group had lower odds of inpatient mortality (0.06, 95% CI 0.02 – 0.15, p<0.001), cardiac arrest (0.08, 95% CI 0.01 – 0.52, p=0.008), vasopressor use (0.07, 95% CI 0.02 – 0.25, p<0.001) and acute renal failure (0.27, 95% CI 0.13 – 0.53, p<0.001) compared to systemic thrombolysis group. The odds of intracranial hemorrhage were the same between the two groups (p=0.565). Patients having mechanical thrombectomy had shorter hospital stay (mean difference 3.6 days, p<0.001) and lower hospital charge (mean difference 104,395 USD, p<0.001). Mechanical thrombectomy in COVID-related PE leads to better patient outcomes; especially inpatient mortality, cardiac arrest, vasopressor use, and acute renal failure compared to systemic thrombolysis.