Utilization and Outcomes of Thrombolytic Therapy for Acute Pulmonary Embolism A Nationwide Cohort Study

被引:37
|
作者
Beyer, Sebastian E. [1 ]
Shanafelt, Colby [1 ]
Pinto, Duane S. [2 ]
Weinstein, Jeffrey L. [3 ]
Aronow, Herbert D. [5 ,6 ]
Weinberg, Ido [7 ]
Yeh, Robert W. [2 ,4 ]
Secemsky, Eric A. [2 ,4 ]
Carroll, Brett J. [2 ]
机构
[1] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02115 USA
[2] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Cardiovasc Med, Boston, MA 02115 USA
[3] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Intervent Radiol, Boston, MA 02115 USA
[4] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Smith Ctr Outcomes Res Cardiol, Boston, MA 02115 USA
[5] Brown Univ, Warren Alpert Med Sch, Rhode Isl Hosp, Div Cardiol, Providence, RI 02912 USA
[6] Brown Univ, Warren Alpert Med Sch, Miriam Hosp, Div Cardiol, Providence, RI 02912 USA
[7] Harvard Med Sch, Massachusetts Gen Hosp, Inst Heart Vasc & Stroke Care, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
acute pulmonary embolism; catheter-directed thrombolysis; ultrasound-assisted thrombolysis; CATHETER-DIRECTED THROMBOLYSIS; INTRACRANIAL HEMORRHAGE; RISK; INTERMEDIATE; TRIAL; MANAGEMENT;
D O I
10.1016/j.chest.2019.10.049
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: There are increased options to deliver thrombolytic treatment for acute, high risk pulmonary embolism (PE). The goals of this study were to examine practice patterns of systemic thrombolysis and catheter-directed thrombolysis (CDT) and to compare outcomes following CDT with ultrasound facilitation (CDT-ultrasound) and CDT alone. METHODS: The study analyzed adults aged > 18 years with hospitalizations associated with acute PE and thrombolysis in the 2016 Nationwide Readmissions Database. The study identified characteristics associated with the use of systemic thrombolysis and CDT. Comparisons of CDT-ultrasound vs CDT alone were then made by evaluating in-hospital events and readmissions. The primary outcomes were in-hospital mortality and 30-day readmission rates. RESULTS: Among 5,436 hospitalizations, systemic thrombolysis was used more often (n = 3,376; 62.1%) than CDT (n = 2,060; 37.9%). Compared with CDT, systemic thrombolysis was used more frequently in patients with higher rates of vasopressor use (4.3% vs 1.0%), shock (15.8% vs. 6.9%), cardiac arrest (12.7% vs 3.4%), and mechanical ventilation (19.0% vs 5.9%). Among patients who underwent CDT, 417 (20.2%) received CDT-ultrasound, and 1,643 (79.8%) received CDT alone. Rates of bleeding events, vasopressor use, and mechanical ventilation were similar between therapeutic strategies. Following adjustment, in-hospital mortality (OR, 1.19; 95% CI, 0.63-2.26; P = .59) and 30-day readmission rates (OR, 0.75; 95% CI, 0.47-1.22; P = .25) were not significantly different between CDT-ultrasound and CDT alone. CONCLUSIONS: Systemic thrombolysis is used more often than CDT in patients with acute PE, in particular among those with a greater prevalence of high-risk features. Among patients treated with CDT, there were no differences in events between CDT-ultrasound and CDT alone.
引用
收藏
页码:645 / 653
页数:9
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