Ultrasound-Assisted versus Standard Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: Insights From National Inpatient Sample—Coverage of ACC 2024 | SCAI

Why is this study important?

  • Current therapy of acute pulmonary embolism (PE) has shifted from previous systemic thrombolytic and anticoagulation use to thrombolysis using either standard catheter-directed thrombolysis (SCDT) or ultrasound-assisted catheter-directed thrombolysis (USAT) in intermediate and high-risk PE patients.
  • SCDT is based on the theory that the local application of thrombolytics as compared to systemic thrombolytic use can reduce the required dose as well as bleeding complications. USAT additionally causes ultrasound-mediated thrombus disruption which increases the surface area of the thrombus exposed to the local lytic agent.
  • USAT is a more expensive technology than SCDT for the treatment of acute pulmonary embolism.
  • Current evidence comparing these two modalities is scarce.

What question was this study supposed to answer?

  • The current study compared the trends, outcomes, and predictors of in-hospital mortality with the use of SCDT and USAT in the treatment of acute pulmonary embolism.

What did the study show?

  • The study analyzed data collected from the National Inpatient Sample (NIS) between the years 2016 and 2020. Multivariable regression analysis was performed to compare the outcomes.
  • The primary outcome was in-hospital mortality.
  • The secondary outcomes were intracranial hemorrhage, non-intracranial bleeding, bleeding requiring transfusion, and healthcare resource utilization.
  •  A total of 39,430 patients from the NIS were studied. Of these, 26,710 (76.8%) patients had received SCDT and 8060 (23.2%) patients had received USAT.
  • There was no significant difference in the incidence of in-hospital mortality between SCDT and USAT (odds ratio, 0.75; 95% CI, 0.52-1.08; P = 0.13).
  • There was no significant difference in the rate of bleeding adverse events between the SCDT and USAT groups.
  • The limitation of the study was that it was observational and retrospective.
  • In conclusion, SCDT and USAT modalities for the treatment of acute pulmonary embolism are comparable with respect to in-hospital mortality and bleeding outcomes in the short term. Long-term outcomes with these modalities will require further study.
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