Outcomes of Catheter-Directed Therapy Plus Anticoagulation Versus Anticoagulation Alone for Submassive and Massive Pulmonary Embolism

Charles T Hennemeyer, Abdul Khan, Hugh McGregor, Cheyenne Moffett, Gregory Woodhead

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. Methods: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over 2 years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8), or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed. Results: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (P <.001) in the CDT group and from 1.40 ± 0.37 to 1.25 ± 0.32 (P =.01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05 ± 0.38 vs 1.20 ± 0.31, P <.001). In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the 2 treatment groups. Ninety-day mortality (11% and 14%, p = 0.7) and incidence of major bleeding complications did not significantly differ between the 2 groups. Thirty-day readmission rates were 8% in the CDT group and 26% in the anticoagulation group (P =.04). Conclusion: CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared with anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pulmonary Embolism
Catheters
Patient Readmission
Dilatation
Therapeutics
Hemorrhage
Thrombectomy
Mortality
Complementary Therapies
Group Psychotherapy
Heparin
Safety
Incidence

Keywords

  • Pulmonary embolism

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Outcomes of Catheter-Directed Therapy Plus Anticoagulation Versus Anticoagulation Alone for Submassive and Massive Pulmonary Embolism. / Hennemeyer, Charles T; Khan, Abdul; McGregor, Hugh; Moffett, Cheyenne; Woodhead, Gregory.

In: American Journal of Medicine, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. Methods: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over 2 years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8), or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed. Results: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (P <.001) in the CDT group and from 1.40 ± 0.37 to 1.25 ± 0.32 (P =.01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05 ± 0.38 vs 1.20 ± 0.31, P <.001). In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the 2 treatment groups. Ninety-day mortality (11{\%} and 14{\%}, p = 0.7) and incidence of major bleeding complications did not significantly differ between the 2 groups. Thirty-day readmission rates were 8{\%} in the CDT group and 26{\%} in the anticoagulation group (P =.04). Conclusion: CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared with anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.",
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AU - Hennemeyer, Charles T

AU - Khan, Abdul

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AU - Woodhead, Gregory

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N2 - Background: Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. Methods: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over 2 years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8), or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed. Results: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (P <.001) in the CDT group and from 1.40 ± 0.37 to 1.25 ± 0.32 (P =.01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05 ± 0.38 vs 1.20 ± 0.31, P <.001). In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the 2 treatment groups. Ninety-day mortality (11% and 14%, p = 0.7) and incidence of major bleeding complications did not significantly differ between the 2 groups. Thirty-day readmission rates were 8% in the CDT group and 26% in the anticoagulation group (P =.04). Conclusion: CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared with anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.

AB - Background: Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. Methods: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over 2 years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8), or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed. Results: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (P <.001) in the CDT group and from 1.40 ± 0.37 to 1.25 ± 0.32 (P =.01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05 ± 0.38 vs 1.20 ± 0.31, P <.001). In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the 2 treatment groups. Ninety-day mortality (11% and 14%, p = 0.7) and incidence of major bleeding complications did not significantly differ between the 2 groups. Thirty-day readmission rates were 8% in the CDT group and 26% in the anticoagulation group (P =.04). Conclusion: CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared with anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.

KW - Pulmonary embolism

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