Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: A systematic review and meta-analysis

Ismayl, Mahmoud; Ismayl, Ahmad; Hamadi, Dana; Aboeata, Ahmed; Goldsweig, Andrew M.

doi:10.1016/j.carrev.2023.10.002

Cited by 6 publications

(2 citation statements)

References 18 publications

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“…There is a paucity of randomized controlled studies comparing the efficacy and safety of different advanced therapies [ 26 , 27 ]. Studies comparing different treatment regimens are mostly retrospective and non-randomized [ 28 – 30 ]. Most studies describing the utility of advanced therapies are single-arm studies [ 31 – 34 ].…”

Section: Discussionmentioning

confidence: 99%

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

Rehman,

Singh,

Sridhar

et al. 2024

Respir Res

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Background Management of PE has become streamlined with the implementation of PE Response Teams (PERT). Race, ethnicity and insurance status are known to influence the outcomes of patients with acute PE. However, whether the implementation of PERT-based care mitigates these racial and ethnic disparities remains unknown. Our aim was to assess the association of race, ethnicity and insurance with outcomes for patients with acute PE managed by PERT. Methods We performed a retrospective chart review of 290 patients with acute PE, who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (New York, NY) from January 2021 to October 2023. A propensity score-weighted analysis was performed to explore the association of race, ethnicity and insurance status with overall outcomes. Results Median age of included patients was 65.5 years and 149 (51.4%) were female. White, Black and Asian patients constituted 56.2% (163), 39.6% (115) and 3.5% [10] of the cohort respectively. Patients of Hispanic or Latino ethnicity accounted for 8.3% [24] of the sample. The 30-day rates of mortality, major bleeding and 30-day re-admission were 10.3%, 2.1% and 12.8% respectively. Black patients had higher odds of major bleeding (odds ratio [OR]: 1.445; p < 0.0001) when compared to White patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving catheter-directed thrombolysis (OR: 0.966; p = 0.0003) and catheter-directed or surgical embolectomy (OR: 0.906; p < 0.0001) when compared to non-Hispanic/Latino patients. Uninsured patients had higher odds of receiving systemic thrombolysis (OR: 1.034; p = 0.0008) and catheter-directed thrombolysis (OR: 1.059; p < 0.0001), and lower odds of receiving catheter-directed or surgical embolectomy (OR: 0.956; p = 0.015) when compared to insured patients, although the odds of 30-day mortality and 30-day major bleeding were not significantly different. Conclusion Within a cohort of PE patients managed by PERT, there were significant associations between race, ethnicity and overall outcomes. Hispanic or Latino ethnicity and uninsured status were associated with lower odds of receiving catheter-directed or surgical embolectomy. These results suggest that disparities related to ethnicity and insurance status persist despite PERT-based care of patients with acute PE.

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Section: Discussionmentioning

confidence: 99%

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

Rehman,

Singh,

Sridhar

et al. 2024

Respir Res

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“…The effectiveness of local and systemic fibrinolysis in patients with intermediate-risk PE remains uncertain due to the potential risk of bleeding: the current indication of systemic fibrinolysis in this subgroup is for subjects undergoing hemodynamic destabilization despite standard anticoagulation and interventional treatments should be considered in those who need a rescue treatment but have contraindications or failed to respond to systemic treatments [34,83,84]. In order to improve the outcomes in this area of therapeutic uncertainty without increasing the bleeding risk, several preclinical studies have focused on inhibiting antifibrinolytic molecules to enhance endogenous thrombolytic activity.…”

Section: Thrombin Activatable Fibrinolysis Inhibitormentioning

confidence: 99%

Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

Falsetti,

Guerrieri,

Zaccone

et al. 2024

JCM

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Pulmonary embolism (PE) is a potentially life-threatening condition requiring prompt diagnosis and treatment. Recent advances have led to the development of newer techniques and drugs aimed at improving PE management, reducing its associated morbidity and mortality and the complications related to anticoagulation. This review provides an overview of the current knowledge and future perspectives on PE treatment. Anticoagulation represents the first-line treatment of hemodynamically stable PE, direct oral anticoagulants being a safe and effective alternative to traditional anticoagulation: these drugs have a rapid onset of action, predictable pharmacokinetics, and low bleeding risk. Systemic fibrinolysis is suggested in patients with cardiac arrest, refractory hypotension, or shock due to PE. With this narrative review, we aim to assess the state of the art of newer techniques and drugs that could radically improve PE management in the near future: (i) mechanical thrombectomy and pulmonary embolectomy are promising techniques reserved to patients with massive PE and contraindications or failure to systemic thrombolysis; (ii) catheter-directed thrombolysis is a minimally invasive approach that can be suggested for the treatment of massive or submassive PE, but the lack of large, randomized controlled trials represents a limitation to widespread use; (iii) novel pharmacological approaches, by agents inhibiting thrombin-activatable fibrinolysis inhibitor, factor Xia, and the complement cascade, are currently under investigation to improve PE-related outcomes in specific settings.

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Kathetergestützte lokale Lysetherapie bei submassiven Lungenembolien

Waßmer,

Koch,

Trips

et al. 2024

Innere Medizin

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Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: A systematic review and meta-analysis

Cited by 6 publications

References 18 publications

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives

Kathetergestützte lokale Lysetherapie bei submassiven Lungenembolien

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