Descriptive analysis of different reperfusion therapies in acute pulmonary embolism

Abstract

Abstract Introduction and objectives: Hemodynamically unstable patients with acute pulmonary embolism (PE) are eligible for systemic thrombolysis (ST). However, catheter-directed therapy (CDT) and surgical thrombectomy (SUT) can also be considered with less clinical evidence. Limited information exists regarding the best reperfusion therapy in this setting. Our objective was to perform a descriptive analysis of different reperfusion therapies in acute pulmonary embolism and determine their safety and efficacy profile. Methods: Retrospective analysis from a prospective single-centre registry of patients admitted with a diagnosis of PE from 2006 through 2021 who required reperfusion therapy. We analyzed the in-hospital outcomes and at 14-day follow up. Results: A total of 50 out of 399 patients admitted with a diagnosis of PE received reperfusion therapies and were included in our analysis. Mean age, 64.5 (53-72), 46% female. This was the reperfusion strategy applied: ST (44%), CDT (42%) and SUT (14%). All patients had right ventricular dilatation and high troponin levels. The overall in-hospital mortality was 18%. Major and minor bleeding rates among the different reperfusion methods were 9.0% vs 4.7% vs 57.4%; P = .001), and 18.1% vs 9.5% vs 14.2%; P = NS), respectively. The 14-day follow-up showed that only CDT and SUT reduced the pulmonary artery systolic pressure while ST and CDT were associated with a reduced right ventricular diameter and an improved right ventricular function. Conclusions: High mortality rates were found in this population with acute PE. No differences were seen regarding effectiveness seen among the different reperfusion strategies used. CDT and SUT may be considered as alternative reperfusion methods especially if ST is contraindicated.

Keywords

• Pulmonary embolism
• Systemic thrombolysis
• Catheter-directed therapy
• Reperfusion therapy
• Surgical thrombectomy