Catheter directed compared to systemically delivered thrombolysis for pulmonary embolism: a systematic review and meta-analysis

Pasha, Ahmed K.; Siddiqui, Muhammad Umer; Siddiqui, Muhammad Danial; Ahmed, Adnan; Abdullah, Ammar; Riaz, Irbaz Bin; Murad, M. Hassan; Bjarnason, Haraldur; Wysokiński, Waldemar E.; McBane, Robert D.

doi:10.1007/s11239-021-02556-7

Cited by 18 publications

(13 citation statements)

References 47 publications

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“…Compared with systemic thrombolysis, CDT was associated with significantly lower in-hospital mortality (risk ratio 0.52, 95% CI 0.40–0.68, P < 0.001). Major bleeding events occurred in 8.2% of patients in the CDT group and 7.9% of patients in the systemic thrombolysis group and were not significantly different between the two treatment modalities (pooled risk ratio 0.80, 95% CI 0.37–1.76, P = 0.58), except for intracranial haemorrhage, which occurred less frequently in patients treated with CDT (RR 0.66, 95% CI 0.47–0.94, P = 0.02) 111 . These data indicate that CDT can reduce the amount of thrombolytics administered but does not eliminate bleeding complications.…”

Section: Interventional Therapiesmentioning

confidence: 87%

“…In addition to these RCTs, a meta-analysis of eight observational studies comprising a total of 11,932 patients with high-risk or intermediate–high-risk PE compared the safety and efficacy of systemic thrombolysis with that of CDT 111 . Compared with systemic thrombolysis, CDT was associated with significantly lower in-hospital mortality (risk ratio 0.52, 95% CI 0.40–0.68, P < 0.001).…”

Section: Interventional Therapiesmentioning

confidence: 99%

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Interventional therapies for pulmonary embolism

et al. 2023

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Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis or surgery; however, a range of percutaneous interventional technologies have been developed that are under investigation in patients with intermediate–high-risk or high-risk PE. These interventional technologies include catheter-directed thrombolysis (with or without ultrasound assistance), aspiration thrombectomy and combinations of the aforementioned principles. These interventional treatment options might lead to a more rapid improvement in right ventricular function and pulmonary and/or systemic haemodynamics in particular patients. However, evidence from randomized controlled trials on the safety and efficacy of these interventions compared with conservative therapies is lacking. In this Review, we discuss the underlying pathophysiology of PE, provide assistance with decision-making on patient selection and critically appraise the available clinical evidence on interventional, catheter-based approaches for PE treatment. Finally, we discuss future perspectives and unmet needs.

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Section: Interventional Therapiesmentioning

confidence: 87%

Section: Interventional Therapiesmentioning

confidence: 99%

Interventional therapies for pulmonary embolism

et al. 2023

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“…For this reason, we did not focus on a specific CDT type, but included all CDT in our analysis ( Table 1 ). In contrast to previous recent analyses ( 35 , 36 ), we compared the techniques which require the involvement of the cath-lab team and specialist equipment against systemic thrombolysis, which can be readily administered in the emergency room. Hence, our analysis was dictated by the practical and organizational considerations.…”

Section: Discussionmentioning

confidence: 99%

Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

Pietrasik

Szarpak

Pruc³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCatheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear.ObjectiveWe conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE.MethodsWe included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay.ResultsEleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88–3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups.ConclusionCDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.

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“…Their initial utilization was based on administration of catheter-directed thrombolytic agents (catheter-directed thrombolysis) directly in contact with the pulmonary arterial thrombus. This method has demonstrated its effectivity and its rational is based on a lower bleeding risk since lower doses of agent are administered during CDT [18,19]. The lower bleeding risk is likely due to the lower total dose of agent administered (e.g., 8 to ∼24 mg during CDT vs. 50–100 mg for intravenous tPA with infusion duration of 4–24 h).…”

Section: Treatment Of Submassive Pulmonary Embolismmentioning

confidence: 99%

Risk stratification and treatment of pulmonary embolism with intermediate-risk of mortality

Pastré

Sanchis-Borja

Benlounes

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewIntermediate-risk pulmonary embolisms (PE) represent a heterogeneous group at the high end of hemodynamically stable patients, characterized by a higher mortality rate. This challenging population gathers many unsolved question regarding its therapeutic management. The purpose of this review is to provide an updated overview of the literature regarding further risk stratification and treatment options in this population.Recent findingsIf anticoagulation represents the undisputed first line of treatment, some patients especially in the intermediate-high risk subgroup may necessitate or could benefit from therapeutic escalation with reperfusion therapies. This includes systemic thrombolysis (ST) or catheter-directed therapies (CDT). ST, despite its high efficacy, is not recommended in this population because of prohibitive bleeding complications. Therefore, reduced-dose ST appears to be a promising option and is actually under evaluation. CDT are percutaneous reperfusion techniques developed to acutely decrease pulmonary vascular obstruction with lower-dose or no thrombolytic agents and, thus, potentially improved safety compared to ST.SummaryGreat progress has been made in the recent years providing a wide range of therapeutic options. Optimal selection of patients who could benefit from these treatments is the key and is based on clinical, biological and radiological parameters evaluating right ventricle function and allowing accurate risk stratification. Pulmonary Embolism Response Team represents an efficient modality for therapeutic management especially in the intermediate-high risk subgroup.

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Catheter directed compared to systemically delivered thrombolysis for pulmonary embolism: a systematic review and meta-analysis

Cited by 18 publications

References 47 publications

Interventional therapies for pulmonary embolism

Interventional therapies for pulmonary embolism

Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients

Risk stratification and treatment of pulmonary embolism with intermediate-risk of mortality

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