Therapy For Submassive Pulmonary Embolism Research Articles

Catheter-assisted local lysis therapy for submassive pulmonary embolism

Pulmonary embolism is the third most common cardiovascular disease. Interventional treatment options as an alternative to systemic lysis therapy of hemodynamically stable, submassive pulmonary embolisms have received an unprecedented boost in innovation in recent years. The treatment options are heterogeneous and can be roughly divided into local thrombolysis and local thrombectomy. For years in our center we have been carrying out catheter-assisted, locoregional lysis therapy with side-hole lysis catheters and acumulative dose per pulmonary branch of 10 mg alteplase over 15 h for hemodynamically stable, submassive pulmonary emboli. The aim of this retrospective study was to review this therapeutic concept and to collect data on clinical endpoints and possible complications. The study included data from 01/2018-03/2023. For this purpose, the patients were selected based on the OPS codes (8.838.60 and 1‑276.0), and the data was collected using the medical records. Biometric data, data on previous illnesses and vital parameters, laboratory chemistry data, CT diagnostic data, echocardiographic data, data on drug treatment and data on complications were collected anonymously. There was asignificant reduction in the strain on the right heart. Peripheral oxygen saturation also improved significantly and heart rate decreased significantly. The complication rate remained low and was almost exclusively limited to access-related problems. Catheter-assisted, locoregional lysis therapy is asafe and effective treatment method for submassive pulmonary embolism.

F-29 | Improvement in hospital and ICU lengths-of-stay among patients receiving catheter-based therapy for submassive pulmonary embolism, 2018-2023

F-29 | Improvement in hospital and ICU lengths-of-stay among patients receiving catheter-based therapy for submassive pulmonary embolism, 2018-2023

Meta-Analysis Comparing Catheter-Directed Thrombolysis Versus Systemic Anticoagulation Alone for Submassive Pulmonary Embolism

The optimal therapy for submassive pulmonary embolism (sPE), defined by right ventricular dysfunction without hemodynamic instability, is uncertain. We conducted a systematic review and meta-analysis to compare the outcomes of catheter-directed thrombolysis (CDT) versus systemic anticoagulation (SA) alone in patients with sPE. We searched PubMed, EMBASE, Cochrane, ClinicalTrials.gov, and Google Scholar (from inception through May 2022) for studies comparing outcomes of CDT versus SA in sPE. Studies were identified, and data were extracted by 2 independent reviewers. We used a random-effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Outcomes included in-hospital, 30-day, 90-day, and 1-year mortality, major and minor bleeding, and need for blood transfusion. A total of 12 studies (1 randomized, 11 observational) with 9,789 patients were included. Compared with SA, CDT was associated with significantly lower in-hospital mortality (RR 0.41, 95% CI 0.30 to 0.56, p <0.00001), 30-day mortality (RR 0.37, 95% CI 0.18 to 0.73,p=0.004), 90-day mortality (RR 0.36, 95% CI 0.17 to 0.72, p=0.004), and a tendency toward lower 1-year mortality (RR 0.56, 95% CI 0.29 to 1.05,p=0.07). The risks of major bleeding (RR 1.31, 95% CI 0.57 to 3.01, p=0.53), minor bleeding (RR 1.67, 95% CI 0.77 to 3.63,p=0.20), and the rates of blood transfusion (RR 0.34, 95% CI 0.10 to 1.15, p=0.08) were similar between the 2 strategies. In conclusion, in patients with sPE, CDT is associated with significantly lower in-hospital, 30-day, and 90-day mortality and a tendency toward lower 1-year mortality with similar bleeding rates compared with SA. This study expands the evidence supporting CDT as first-line therapy for sPE, and randomized controlled trials are indicated to confirm our findings.

C-17 | Catheter-Directed Thrombolysis Versus Systemic Anticoagulation For Submassive Pulmonary Embolism: A Systematic Review And Meta-Analysis

The optimal therapy for submassive pulmonary embolism (PE) remains controversial. We conducted a systematic review and meta-analysis to compare the outcomes of catheter-directed thrombolysis (CDT) versus systemic anticoagulation (SA) alone in patients with submassive PE.

Catheter-directed Thrombolysis versus Systemic Anticoagulation for Submassive Pulmonary Embolism: A Meta-Analysis.

The optimal therapy for submassive pulmonary embolism remains in question. The following meta-analysis compiles the current evidence comparing Catheter-Directed Thrombolysis (CDT) versus Systemic Anticoagulation (SA). An electronic search through PubMed and Google scholar revealed studies comparing CDT versus SA in terms of mortality and major bleeding events. Thirty-day, 90-day, and one-year mortality results were analyzed. Six studies were included in the meta-analysis. Thirty-day and one-year mortality were less with CDT compared to SA (OR 0.27 [CI 0.11-0.67]; and OR 0.50 [CI 0.28-0.89]). Ninety-day mortality was similar between the two methods (OR 0.57 [CI 0.17-1.92]). Compilation of all studies reporting at least greater than 30-day mortality revealed less mortality with CDT (OR 0.51 [0.30-0.86]). Major bleeding was similar between the two treatments (OR 1.63 [CI 0.63-4.20]). CDT has less 30-day and 1-year mortality with equivalent rates of major bleeding compared to SA for treatment of submassive pulmonary embolism.

Controversial Fibrinolytic Therapy for Submassive Pulmonary Embolism Related to Right Heart Thrombus

Controversial Fibrinolytic Therapy for Submassive Pulmonary Embolism Related to Right Heart Thrombus

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism.

Submassive pulmonary embolism (PE) remains a vexing entity, and the appropriate use of thrombolytic therapy for this subgroup continues to be actively debated. Catheter-directed thrombolysis has shown efficacy for submassive PE and is gaining momentum because of theoretically improved safety. This review poses and responds to four questions that explore the complex issues surrounding optimal therapy of submassive PE.

Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO)

Therapy for submassive pulmonary embolism (intermediate risk), remains controversial. New evidence has appeared that may help us in the process of decision making. We review the relevant literature, outline prognostic factors, and discuss current recommendations and controversies regarding the available alternatives such as systemic and catheter-directed thrombolytic use.

Thrombolytic Therapy for Acute Pulmonary Embolism: A Critical Appraisal

Pulmonary embolism (PE) is a prevalent condition that may account for > 300,000 deaths annually in the United States alone. Although thrombolytics have been studied as a treatment for acute PE since the 1960s, to date there have been only 11 randomized controlled trials comparing thrombolytic therapy to conventional anticoagulation, and the numbers of patients included in these trials has been small. Many studies confirm that thrombolytic therapy leads to rapid improvement in hemodynamic aberrations associated with PE, and this approach to massive PE with cardiogenic shock is a guideline-based practice. It is widely accepted that acute PE without associated right ventricular (RV) dysfunction or hemodynamic instability can be readily managed with standard anticoagulation. The appropriate therapy for submassive PE (PE associated with RV dysfunction but preserved systemic arterial BP) remains an area of contention, and definitive data proving mortality benefit in this setting are lacking. Further efforts at risk stratification may better determine who is in need of aggressive therapy. This article reviews historical aspects of and current evidence for thrombolytic therapy in acute PE with specific attention to bleeding risk, and data regarding hemodynamic parameters and mortality. We also discuss risk stratification techniques and propose a clinical algorithm for the incorporation of thrombolytic therapy.

Thrombolytic Therapy for Submassive Pulmonary Embolism?

The purpose of this review was to determine the effectiveness of adding thrombolytics to standard heparin therapy for treatment of submassive pulmonary embolism. Patients with submassive pulmonary embolism were considered to be those with evidence of right ventricular dysfunction but without hemodynamic instability. We searched for trials comparing thrombolytics to heparin in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. We included only studies assessing the effectiveness of thrombolytic therapy for submassive pulmonary embolism and reported the patient-important outcomes of mortality, recurrent pulmonary embolism, and major hemorrhage. Two randomized trials met the inclusion criteria; one with a total of 256 patients presenting with submassive pulmonary embolism and the other trial including a subgroup of 46 patients with submassive pulmonary embolism. In the larger study, the relative risk (RR) for mortality, recurrent pulmonary embolism, and major hemorrhage was 1.56 (95% confidence interval [CI] 0.36 to 6.83), 1.17 (95% CI 0.30 to 4.57), and 0.23 (95% CI 0.03 to 1.97), respectively. Our post hoc subgroup analysis of the smaller trial identified 2 deaths and 5 patients with recurrent pulmonary embolism among 23 controls, whereas none of the 23 patients randomized to thrombolytics died or had recurrent pulmonary embolism. None of these findings were statistically significant. Results of randomized trials comparing the addition of thrombolytic therapy to standard heparin therapy for treatment of submassive pulmonary embolism fail to show any significant differences in clinically important outcomes.

Thrombolytic Therapy for Submassive Pulmonary Embolism

Thrombolytic therapy is recommended for hemodynamically unstable patients with pulmonary embolism (PE). However, there is no consensus on whether thrombolytic therapy is beneficial for patients with submassive PE -- that is, PE with measurable hemodynamic effects that have not resulted in clinical instability. This double-blind, randomized German trial involved 256 patients with acute PE and …