C-46 | In-Hospital Mortality in Patients With Pulmonary Embolism Managed With Ultrasound-Assisted Catheter-Directed Thrombolysis Compared to Systemic Thrombolysis

Abstract

Patients with high-risk or intermediate-risk pulmonary embolism (PE) require more aggressive therapy, such as systemic thrombolysis. Although parenteral systemic thrombolysis leads to faster clot resolution, it is associated with a high risk for significant bleeding and its complications. The use of catheter-directed thrombolysis (CDT) decreases systemic exposure to thrombolytics and reduces the risk of complications and mortality. Adding ultrasound to CDT can potentially decrease the dosing of local thrombolytics and make it even safer for the patients. This retrospective cohort study identified 1,007 patients diagnosed with pulmonary embolism (PE) across several facilities. Patients were stratified into two groups based on the treatment they received, a group that received systemic thrombolysis (ST), 432 (42.9 %), and a group that received ultrasound-assisted catheter-directed thrombolysis (EKOS), 575 (57.1 %). The aim was to explore immediate mortality from direct and indirect complications arising from PE and its management in patients treated with systemic thrombolysis vs. EKOS. We used logistic regression to analyze data. The patients with PE and who were managed with ST were more likely to expire than those treated with EKOS (OR 2.893, CI 1.766∼5.041, p<0.001). Patients who passed were more likely to experience tachycardia (OR 2.432, CI 1,299∼4.556, p<0.001) and use of vasopressors (OR 13.331, CI 8.075∼22.006, p<0.001). There were 70 (6.95 %) deaths in the ST group vs. 26 (2.58 %) in the EKOS group. Patients with PE managed with ST are more likely to die than those managed with EKOS. This illustrates better outcomes of using EKOS vs. systemic thrombolysis for PE. However, a limitation of this study was the small sample of patients and possible cofounders, which warrants future studies.