Sebastian E Beyer1, Colby Shanafelt1, Duane S Pinto2, Jeffrey L Weinstein3, Herbert D Aronow4, Ido Weinberg5, Robert W Yeh6, Eric A Secemsky6, Brett J Carroll7. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 2. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 3. Division of Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 4. Division of Cardiology, Rhode Island and The Miriam Hospitals, Warren Alpert Medical School of Brown University, Providence, RI. 5. Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 6. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 7. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: bcarrol2@bidmc.harvard.edu.
Abstract
BACKGROUND: There are increased options to deliver thrombolytic treatment for acute, high-risk pulmonary embolism (PE). The goals of this study were to examine practice patterns of systemic thrombolysis and catheter-directed thrombolysis (CDT) and to compare outcomes following CDT with ultrasound facilitation (CDT-ultrasound) and CDT alone. METHODS: The study analyzed adults aged > 18 years with hospitalizations associated with acute PE and thrombolysis in the 2016 Nationwide Readmissions Database. The study identified characteristics associated with the use of systemic thrombolysis and CDT. Comparisons of CDT-ultrasound vs CDT alone were then made by evaluating in-hospital events and readmissions. The primary outcomes were in-hospital mortality and 30-day readmission rates. RESULTS: Among 5,436 hospitalizations, systemic thrombolysis was used more often (n = 3,376; 62.1%) than CDT (n = 2,060; 37.9%). Compared with CDT, systemic thrombolysis was used more frequently in patients with higher rates of vasopressor use (4.3% vs 1.0%), shock (15.8% vs. 6.9%), cardiac arrest (12.7% vs 3.4%), and mechanical ventilation (19.0% vs 5.9%). Among patients who underwent CDT, 417 (20.2%) received CDT-ultrasound, and 1,643 (79.8%) received CDT alone. Rates of bleeding events, vasopressor use, and mechanical ventilation were similar between therapeutic strategies. Following adjustment, in-hospital mortality (OR, 1.19; 95% CI, 0.63-2.26; P = .59) and 30-day readmission rates (OR, 0.75; 95% CI, 0.47-1.22; P = .25) were not significantly different between CDT-ultrasound and CDT alone. CONCLUSIONS: Systemic thrombolysis is used more often than CDT in patients with acute PE, in particular among those with a greater prevalence of high-risk features. Among patients treated with CDT, there were no differences in events between CDT-ultrasound and CDT alone.
BACKGROUND: There are increased options to deliver thrombolytic treatment for acute, high-risk pulmonary embolism (PE). The goals of this study were to examine practice patterns of systemic thrombolysis and catheter-directed thrombolysis (CDT) and to compare outcomes following CDT with ultrasound facilitation (CDT-ultrasound) and CDT alone. METHODS: The study analyzed adults aged > 18 years with hospitalizations associated with acute PE and thrombolysis in the 2016 Nationwide Readmissions Database. The study identified characteristics associated with the use of systemic thrombolysis and CDT. Comparisons of CDT-ultrasound vs CDT alone were then made by evaluating in-hospital events and readmissions. The primary outcomes were in-hospital mortality and 30-day readmission rates. RESULTS: Among 5,436 hospitalizations, systemic thrombolysis was used more often (n = 3,376; 62.1%) than CDT (n = 2,060; 37.9%). Compared with CDT, systemic thrombolysis was used more frequently in patients with higher rates of vasopressor use (4.3% vs 1.0%), shock (15.8% vs. 6.9%), cardiac arrest (12.7% vs 3.4%), and mechanical ventilation (19.0% vs 5.9%). Among patients who underwent CDT, 417 (20.2%) received CDT-ultrasound, and 1,643 (79.8%) received CDT alone. Rates of bleeding events, vasopressor use, and mechanical ventilation were similar between therapeutic strategies. Following adjustment, in-hospital mortality (OR, 1.19; 95% CI, 0.63-2.26; P = .59) and 30-day readmission rates (OR, 0.75; 95% CI, 0.47-1.22; P = .25) were not significantly different between CDT-ultrasound and CDT alone. CONCLUSIONS:Systemic thrombolysis is used more often than CDT in patients with acute PE, in particular among those with a greater prevalence of high-risk features. Among patients treated with CDT, there were no differences in events between CDT-ultrasound and CDT alone.
Authors: Arkadiusz Pietrasik; Aleksandra Gąsecka; Łukasz Szarpak; Michał Pruc; Tomasz Kopiec; Szymon Darocha; Marta Banaszkiewicz; Maciej Niewada; Marcin Grabowski; Marcin Kurzyna Journal: Front Cardiovasc Med Date: 2022-06-16
Authors: Brett J Carroll; Sebastian E Beyer; Tyler Mehegan; Andrew Dicks; Abby Pribish; Andrew Locke; Anuradha Godishala; Kevin Soriano; Jaya Kanduri; Kelsey Sack; Inbar Raber; Cara Wiest; Isabel Balachandran; Mason Marcus; Louis Chu; Margaret M Hayes; Jeff L Weinstein; Kenneth A Bauer; Eric A Secemsky; Duane S Pinto Journal: Am J Med Date: 2020-05-19 Impact factor: 4.965
Authors: Efthymios D Avgerinos; Wissam Jaber; Joan Lacomis; Kyle Markel; Michael McDaniel; Belinda N Rivera-Lebron; Charles B Ross; Jacob Sechrist; Catalin Toma; Rabih Chaer Journal: JACC Cardiovasc Interv Date: 2021-06-28 Impact factor: 11.075