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Year : 2021  |  Volume : 23  |  Issue : 1  |  Page : 50-58

Comparison of catheter-directed thrombolysis and anticoagulation in intermediate-risk pulmonary embolism: A retrospective analysis

1 Department of Anesthesiology and Critical Care, Haseki Sultangazi Education and Research Hospital, Turkey University of Health Sciences, Istanbul, Turkey
2 Department of Cardiology, International Medical School, Istanbul Medipol University, Istanbul, Turkey

Correspondence Address:
Derya Ozden Omaygenc
Uğur Mumcu, Hastane Av. No: 1 A D: 1B, 34265 Sultangazi, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejop.ejop_73_20

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BACKGROUND AND OBJECTIVES: The selection of escalation of care strategies for the treatment of intermediate-risk pulmonary embolism (PE) is a matter of debate. Here, we aimed to assess the features of our population treated either with anticoagulation (AC) alone or catheter-directed thrombolysis (CDT). We also sought to identify a relationship between high residual systolic pulmonary artery pressure (sPAP) and demographic and clinical variables. PATIENTS AND METHODS: The retrospective data of 30 intermediate-high-risk PE patients were analyzed. CDT was used in 14 (46.7%) cases. Enoxaparin (b. i. d) injections were administered in the AC group. In the CDT group, patients received 5 mg bolus dose of alteplase followed by 1 mg/h infusion for 24 h. Estimated sPAP at presentation and discharge was recorded. A value equal to or greater than 40 mmHg in the latter was accepted as a significant rise. RESULTS: The patients in the CDT group had a lower HAS-BLED score (2 [0–3] vs. 1 [0–3], P = 0.03). Although initial sPAP values were comparable among treatment arms, sPAP at discharge was significantly lower in the CDT group (mmHg, 42 ± 11.2 vs. 33.6 ± 9.7, P = 0.04). The reduction in sPAP at discharge was also significantly higher in this group. The degree of reduction in sPAP was considerably correlated with baseline sPAP (r: 63.2, P < 0.001). Finally, the baseline sPAP measurement and HAS-BLED score of the patients with high residual sPAP were significantly higher (56.6 ± 13.1 vs. 67.3 ± 11.3, P = 0.02, and 1 [0–3] vs. 2 [0–3], P = 0.02, respectively). CONCLUSION: CDT was preferred over AC when lower bleeding risk was anticipated for intermediate-high-risk PE patients in our sample population. Eventually, CDT provided lower discharge sPAP levels and a greater reduction in sPAP. However, the factors associated with high sPAP at discharge were only high baseline sPAP measurement and HAS-BLED score.

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