Comparison of Catheter-Directed Thrombolysis vs Systemic Thrombolysis in Pulmonary Embolism: A Propensity Score Match Analysis

Abstract

SESSION TITLE: Prevention and Treatment of Venous Thromboembolism SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 11:00 AM - 12:15 PM PURPOSE: In acute pulmonary embolism (PE), systemic thrombolysis(ST) therapy leads to early hemodynamic improvement, but associated with major bleeding, and is withheld in many patients at risk. Whether catheter directed thrombolysis(CDT) is superior to systemic thrombolysis in high risk PE patients is still unclear. We aim to evaluate this in our study. METHODS: The study cohort was derived from the HCUP’s National Readmission Data (NRD) 2013-2014, sponsored by the AHRQ. PE was identified by ICD 9 CM code-415.11/13/19 in primary diagnosis filed. ST and CDT were identified appropriate ICD 9 codes in primary or secondary procedural field. The primary outcome was in hospital mortality and 30-day readmission and secondary outcome was in hospital mortality and/or major bleeding events [Intra cranial hemorrhage(ICH) + Gastrointestinal Bleed (GI bleed)]. The propensity score match (1:2) and hierarchical two level logistic model were used to adjust confounders. RESULTS: Overall 4426 PE patients were identified, of which 1128 matched pairs were taken into consideration (1:2). There was no statistical significance in baseline characteristics after adjusting propensity score match. In-hospital mortality (6.12% vs. 14.94%, p < 0.001), 30-day readmission (7.65% vs 10.58%, p=0.009) and secondary outcomes (8.42% vs 18.13%, <0.001) were lower in propensity matched cohort with CDT as compared to ST. similar results were observed with hierarchical multivariate method (OR, 95 % CI, p value) (Primary:0.29, 0.38- 0.50, p<0.001) and (secondary: 0.44, 0.35-0.55, p<0.001). Discharge to facility (11.79 vs. 14.1, <0.001) was lower with CDT vs. ST in propensity match cohort. GI bleed, blood transfusion and length of stay were also statistically significantly lower among CDT patients after adjusting for propensity score match. CONCLUSIONS: In Pulmonary Embolism treatment, use of CDT is superior compared to systemic thrombolysis in terms of in hospital mortality and major bleeding complications. Further large scale studies are required to further assess the effectiveness of CDT. CLINICAL IMPLICATIONS: This study suggests superior clinical outcomes including major bleeding with use of CDT as compared to ST in patients with PE. Large patient population and robust statistical method was used to analyze clinical outcomes. In this patient population, use of CDT is still underutilized due to various reservations. By publishing our data we hope that CDT will be appropriately utilized in eligible patients. DISCLOSURE: The following authors have nothing to disclose: Abhishek Mishra, Sukriti Kamboj, Purav Shah, Harshil Shah, Shilkumar Arora, Safi Khan, Varun Kumar, Sidakpal Panaich, Apurva Badheka, Navin Subrayappa No Product/Research Disclosure Information