Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis

Nish Patel, Nileshkumar J. Patel, Kanishk Agnihotri, Sidakpal S. Panaich, Badal Thakkar, Achint Patel, Chirag Savani, Nilay Patel, Shilpkumar Arora, Abhishek Deshmukh, Parth Bhatt, Carlos E Alfonso, Mauricio G Cohen, Alfonso Tafur, Mahir Elder, Tamam Mohamed, Ramak Attaran, Theodore Schreiber, Cindy Grines, Apurva O. Badheka

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Objective The aim of the study was to assess the utilization of catheter-directed thrombolysis (CDT) and its comparative effectiveness against systemic thrombolysis in acute pulmonary embolism (PE). Background Contemporary real world data regarding utilization and outcomes comparing systemic thrombolysis with CDT for PE is sparse. Methods We queried the Nationwide Inpatient Sample from 2010 to 2012 using the ICD-9-CM diagnosis code 415.11, 415.13, and 415.19 for acute PE. We used propensity score analysis to compare outcomes between systemic thrombolysis and CDT. Primary outcome was in-hospital mortality. Secondary outcome was combined in-hospital mortality and intracranial hemorrhage (ICH). Results Out of 110,731 patients hospitalized with PE, we identified 1,521 patients treated with thrombolysis, of which 1,169 patients received systemic thrombolysis and 352 patients received CDT. After propensity-matched comparison, primary and secondary outcomes were significantly lower in the CDT group compared to systemic thrombolysis (21.81% vs. 13.36%, OR 0.55, 95% CI 0.36-0.85, P value = 0.007) and (22.89% vs. 13.36%, OR 0.52, 95% CI 0.34-0.80, P value = 0.003), respectively. The median length of stay [7 days, interquartile range (IQR) (5-9 days) vs. 7 days, IQR (5-10 days), P = 0.17] was not significant between the two groups. The CDT group had higher cost of hospitalization [$17,218, IQR ($12,272-$23,906) vs. $23,799, IQR ($17,892-$35,338), P <0.001]. Multivariate analysis identified increasing age, saddle PE, cardiopulmonary arrest, and Medicaid insurance as independent predictors of in-hospital mortality. Conclusions CDT was associated with lower in-hospital mortality and combined in-hospital mortality and ICH.

Original languageEnglish (US)
Pages (from-to)1219-1227
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number7
DOIs
StatePublished - Dec 1 2015

Keywords

  • CDT
  • fibrinolysis
  • hospitalization
  • outcomes research
  • peripheral interventions
  • pulmonary embolism
  • thrombolysis
  • trends
  • venous thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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