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Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis
Journal article   Peer reviewed

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, …
Catheterization and cardiovascular interventions, Vol.86(7), pp.1219-1227
12/01/2015
DOI: 10.1002/ccd.26108
PMID: 26308961

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Abstract

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). Contemporary real world data regarding utilization and outcomes comparing systemic thrombolysis with CDT for PE is sparse. 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). 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. CDT was associated with lower in-hospital mortality and combined in-hospital mortality and ICH.
 Multivariate Analysis Catheterization, Swan-Ganz - trends United States Humans Middle Aged Catheterization, Swan-Ganz - utilization Male Fibrinolytic Agents - adverse effects Catheterization, Swan-Ganz - mortality Time Factors Thrombolytic Therapy - methods Adult Female Medicaid Odds Ratio Thrombolytic Therapy - trends Databases, Factual Thrombolytic Therapy - utilization Hospital Mortality Medicare Risk Factors Catheterization, Swan-Ganz - adverse effects Logistic Models Treatment Outcome Chi-Square Distribution Thrombolytic Therapy - mortality Practice Patterns, Physicians' - trends Pulmonary Embolism - mortality Propensity Score Pulmonary Embolism - diagnosis Intracranial Hemorrhages - chemically induced Pulmonary Embolism - drug therapy Aged Fibrinolytic Agents - administration & dosage Thrombolytic Therapy - adverse effects

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