Nationwide Trends in Use of Catheter-Directed Therapy for Treatment of Pulmonary Embolism in Medicare Beneficiaries from 2004 to 2016

Gayou, Edward L.; Makary, Mina S.; Hughes, Danny R.; Hemingway, Jennifer; Elliott, Eric; Spain, James; Prevedello, Luciano M.

doi:10.1016/j.jvir.2019.02.024

Cited by 31 publications

(18 citation statements)

References 17 publications

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“…Such studies are very often single-centre and based on a small number of cases. A few controlled, randomised trials have been performed, but with limited sample sizes and haemodynamic stability as the endpoint [5,33,43,44,45,46]. By contrast, available data does not support the routine use of systemic thrombolytic therapy or endovascular procedures for patients with intermediate-high-risk PE.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Surgical management can induce serious potential complications, including atrial fibrillation, tamponade, and right heart failure. In-hospital mortality rates of 2 recent studies with intermediate and high risk PE was range 6.6–11.7% [ 43 , 44 ], and the 30-day mortality was only 4.6 % in a third study [ 45 ]. Thus, surgical embolectomy is useful to treat patients with large proximal or intracardiac thrombi with a risk of paradoxical embolism via a patent foramen ovale, in expert surgical centers.…”

Section: State Of the Art Of Reperfusion Therapiesmentioning

confidence: 99%

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Endovascular therapies for pulmonary embolism

Rousseau

Giudice²,

Sanchez

et al. 2021

Heliyon

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Purpose The aim of this article is to define the place of new endovascular methods for the management of pulmonary embolisms (PE), on the basis of a multidisciplinary consensus. Method and results Briefly, from the recent literature, for high-risk PE presenting with shock or cardiac arrest, systemic thrombolysis or embolectomy is recommended, while for lowrisk PE, anticoagulation alone is proposed. Normo-tense patients with PE but with biological or imaging signs of right heart dysfunction constitute a group known as “at intermediate risk” for which the therapeutic strategy remains controversial. In fact, some patients may require more aggressive treatment in addition to the anticoagulant treatment, because approximately 10% will decompensate hemodynamically with a high risk of mortality. Systemic thrombolysis may be an option, but with hemorrhagic risks, particularly intra cranial. Various hybrid pharmacomechanical approaches are proposed to maintain the benefits of thrombolysis while reducing its risks, but the overall clinical experience of these different techniques remains limited. Patients with high intermediate and high risk pulmonary embolism should be managed by a multidisciplinary team combining the skills of cardiologists, resuscitators, pneumologists, interventional radiologists and cardiac surgeons. Such a team can determine which intervention – thrombolysis alone or assisted, percutaneous mechanical fragmentation of the thrombus or surgical embolectomy – is best suited to a particular patient. Conclusions This consensus document define the place of endovascular thrombectomy based on an appropriate risk stratification of PE.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: State Of the Art Of Reperfusion Therapiesmentioning

confidence: 99%

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Endovascular therapies for pulmonary embolism

Rousseau

Giudice²,

Sanchez

et al. 2021

Heliyon

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“…Important aspects of evidence‐to‐practice translation are both the overuse and underuse of treatments. Examples of overuse include placement of inferior vena cava filters for primary prophylaxis in patients at risk for VTE and use of catheter‐directed thrombolysis for treating patients with intermediate‐ and high‐risk PE without randomized trial evidence supporting mortality benefits 29‐31 . Examples of underuse include differential DOAC prescribing and low use of outpatient DVT treatment based on race and socioeconomic factors 32,33 .…”

Section: T3 – Translational Research: From Patients To Clinical Practicementioning

confidence: 99%

“…While large-scale clinical trials can establish the efficacy of various interventions (both prophylactic and treatment), implementing these into clinical practice (T3 research) remains a barrier to improved health. Important aspects of evidence-to-practice translation are both the overuse and underuse of treatments.Examples of overuse include placement of inferior vena cava filters for primary prophylaxis in patients at risk for VTE and use of catheter-directed thrombolysis for treating patients with intermediate-and high-risk PE without randomized trial evidence supporting mortality benefits [29][30][31]. Examples of underuse include differential DOAC prescribing and low use of outpatient…”

mentioning

confidence: 99%

Venous thromboembolism research priorities: A scientific statement from the American Heart Association and the International Society on Thrombosis and Haemostasis

Cushman

Barnes

Creager

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Venous thromboembolism (VTE) is a major cause of morbidity and mortality. The impact of the Surgeon General's Call to Action in 2008 has been lower than expected given the public health impact of this disease. This scientific statement highlights future research priorities in VTE, developed by experts and a crowdsourcing survey across 16 scientific organizations. At the fundamental research level (T0), researchers need to identify pathobiologic causative mechanisms for the 50% of patients with unprovoked VTE and better understand mechanisms that differentiate hemostasis from thrombosis. At the human level (T1), new methods for diagnosing, treating, and preventing VTE will allow tailoring of diagnostic and therapeutic approaches to individuals. At the patient level (T2), research efforts are required to understand how foundational evidence impacts care of patients (eg, biomarkers). New treatments, such as catheter-based therapies, require further testing to identify which patients are most likely to experience benefit. At the practice level (T3), translating evidence into practice remains challenging. Areas of overuse and underuse will require evidence-based tools to improve care delivery. At the community and population level (T4), public awareness campaigns need thorough impact assessment. Large population-based cohort studies can elucidate the biologic and environmental underpinings of VTE and its complications. To achieve these goals, funding agencies and training

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A cross‐sectional study of outcomes for patients undergoing mechanical thrombectomy for pulmonary embolism during 2018–2022: Insights from the PINC AI Healthcare Database

Gandhi,

Gibson,

Jaber

2024

Health Science Reports

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Background and AimsMechanical thrombectomy (MT) treatments for pulmonary embolism (PE) have yet to be compared directly. We aimed to determine if patient outcomes varied following treatment of PE with different MT devices.MethodsAll PE encounters with an index treatment of MT between January 2018 and March 2022 were analyzed for in‐hospital mortality, discharge to home, and 30‐day readmission outcomes in the PINC AI™ Healthcare Database. MT devices used in each encounter were extracted from hospital charge description free‐text fields using keyword text and fuzzy matching. Unadjusted and adjusted logistic regression was used to model outcomes by device.ResultsA total of 5893 encounters were identified using MT as the sole index PE treatment and 1812 using MT with another treatment. Of these, 41% had insufficient information to identify the devices used (unspecified MT), 33% used the FlowTriever System (large‐bore volume‐controlled aspiration MT), 23% the Indigo System (continuous aspiration MT), and 3% some other MT. Large‐bore volume‐controlled aspiration MT was used with other treatments 13% of the time compared with 23% and 39% for unspecified MT and continuous aspiration MT, respectively. Adjusted logistic regression modeling revealed the odds of in‐hospital mortality were significantly higher for patients treated with unspecified MT ([OR] = 1.42, 95% confidence interval [CI]: [1.10–1.83], p = 0.008) or continuous aspiration MT (OR = 1.63, 95% CI: [1.21–2.19], p = 0.001) compared with large‐bore volume‐controlled aspiration MT. Discharge to home was significantly lower in these same groups (OR = 0.84, 95% CI: [0.73–0.96], p = 0.01, and OR = 0.63, 95% CI: [0.53–0.74], p < 0.001, respectively), but readmission risks at 30 days were comparable (OR = 1.08, 95% CI: [0.84–1.38], p = 0.56, and OR = 1.20, 95% CI: [0.89–1.62], p = 0.24, respectively).ConclusionPE outcomes and treatment patterns differ significantly based on the type of MT utilized. Clinical studies directly comparing MT treatments are needed to further understand optimal treatment of PE.

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Nationwide Trends in Use of Catheter-Directed Therapy for Treatment of Pulmonary Embolism in Medicare Beneficiaries from 2004 to 2016

Cited by 31 publications

References 17 publications

Endovascular therapies for pulmonary embolism

Endovascular therapies for pulmonary embolism

Venous thromboembolism research priorities: A scientific statement from the American Heart Association and the International Society on Thrombosis and Haemostasis

A cross‐sectional study of outcomes for patients undergoing mechanical thrombectomy for pulmonary embolism during 2018–2022: Insights from the PINC AI Healthcare Database

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