Catheter-directed thrombolysis boosts survival rates for submassive pulmonary embolism

Catheter-directed thrombolysis (CDT) is associated with significantly lower short-term mortality rates among submassive pulmonary embolism (PE) patients than anticoagulation alone, according to a new meta-analysis published in the American Journal of Cardiology.

“Acute PE is the third most common cause of cardiovascular death in the United States,” wrote first author Mahmoud Ismayl, MD, a specialist with Creighton University School of Medicine in Omaha, Nebraska, and colleagues. “Almost one-quarter of hemodynamically stable PE patients have submassive PE, defined by hemodynamic stability but evidence of right ventricular (RV) dysfunction on imaging or abnormal cardiac biomarkers. The optimal strategy for managing acute submassive PE remains debated.”

Ismayl et al. examined data from nearly 10,000 patients who participated in one of 12 studies from 2014 to 2022. While 11 studies were observational, the 12th was a randomized controlled trial (RCT). Two different researchers independently extracted the data for analysis.

Reviewing the studies, the authors found that CDT was consistently associated with much lower in-hospital, 30-day and 90-day mortality than systemic anticoagulation. A “tendency toward lower one-year mortality and improved RV recovery” for CDT was also observed.

Hospital lengths of stay were similar between the two treatment options. The same was also true for the rates of major bleeding events, minor bleeding events and blood transfusions.

A previous meta-analysis in Current Cardiology Reviews had found that 90-day mortality rates after CDT and anticoagulation alone were similar, but Ismayl and colleagues emphasized that their research included twice as many studies and many more patients than that group’s study.

“This study expands the evidence supporting CDT as first-line therapy for submassive PE, and more RCTs are indicated to confirm our findings,” the authors wrote.

The team did note that their meta-analysis had certain limitations. Most of its studies were observational in nature, for example, and patients were treated with two different kinds of CDT—ultrasound-assisted CDT or conventional CDT—instead of one consistent treatment across the board.

“Third, like all meta-analyses, the quality of our study depends upon the quality of the included studies,” the authors added. “Despite these limitations, our study is strengthened by a large number of included studies and minimal heterogeneity in the selected studies.”

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Reference:

1. Mahmoud Ismayl, MD; Akshay Machanahalli Balakrishna, MD; Ahmed Aboeata, MD, et al. Meta-Analysis Comparing Catheter-Directed Thrombolysis Versus Systemic Anticoagulation Alone for Submassive Pulmonary Embolism. American Journal of Cardiology, June, 2022.

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