Elsevier

The American Journal of Cardiology

Volume 139, 15 January 2021, Pages 116-120
The American Journal of Cardiology

Effects of Thrombolytic Therapy in Low-Risk Patients With Pulmonary Embolism

https://doi.org/10.1016/j.amjcard.2020.09.031Get rights and content

We performed this investigation to determine the effects on mortality of thrombolytic therapy in low-risk patients with pulmonary embolism (PE). This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016 and 2017. Patients with a primary (first-listed) diagnosis of acute PE who were not in shock and not on a ventilator who did not have acute cor pulmonale were defined as low-risk. Patients were identified by International Classification of Diseases-10-Clinical Modification Codes. Mortality was assessed according to treatment with catheter-directed thrombolysis, intravenous thrombolytic therapy, or anticoagulants alone. Mortality with inferior vena cava (IVC) filters was also assessed. Mortality was lowest in low-risk patients treated with anticoagulants alone, 6,765 of 331,430 (2.0%). Mortality was somewhat higher with catheter-directed thrombolysis, 195 of 6915 (2.8%; p <0.0001), and highest with intravenous thrombolysis 510 of 5,200 (9.8%; p <0.0001). Matched patients showed similar results. IVC filters did not reduce mortality in patients treated with anticoagulants alone. Mortality was only 0.5% higher in patients treated with anticoagulants who had saddle PE than in patients with nonsaddle PE, 450 of 17,935 (2.5%) versus 6,315 of 313,495 (2.0%; p <0.0001). However, a larger proportion of low-risk patients with saddle PE received catheter-directed thrombolysis than patients who had nonsaddle PE, 2,330 of 21,760 (11%) versus 4,585 of 321,785 (1.4%; p <0.0001). Similarly, a larger proportion of patients with saddle PE received intravenous thrombolytic therapy than patients with nonsaddle PE, 1,495 of 21,760 (6.9%) versus 3,705 of 321,785 (1.2%; p <0.0001). In conclusion, low-risk patients with PE did not have lower mortality with catheter-directed thrombolysis or intravenous thrombolytic therapy than with anticoagulants alone, and IVC filters did not reduce mortality with anticoagulants alone.

Section snippets

Methods

This was a retrospective cohort study based on administrative data from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, January 2016 through December 2017.2 The National Inpatient Sample in 2016 and 2017 was a sample of discharge records from all United States non-Federal, short-term, general, and other specialty hospitals participating in the Healthcare Cost and Utilization Project.2 Weighted estimates of the number of

Results

In 2016 and 2017, 343,545 patients were hospitalized with a primary diagnosis of low-risk PE (Figure 1). None underwent pulmonary embolectomy.

Mortality in low-risk patients with catheter-directed thrombolysis was somewhat higher than with anticoagulants (Table 3). Patients treated with intravenous thrombolytic therapy showed the highest mortality.

Matched low-risk patients showed results that were comparable to results with unmatched patients (Table 3). Mortality was lowest in patients treated

Discussion

The vast majority of low-risk patients with acute PE were treated with anticoagulants. Neither catheter-directed thrombolysis nor intravenous thrombolytic therapy resulted in lower mortality than anticoagulants alone. IVC filters did not reduce mortality in patients treated with anticoagulants alone. These observations are consistent with the recommendation that low-risk patients with PE should be treated with anticoagulants alone.1 Systematic review did not identify any randomized controlled

Disclosures

The authors have no conflicts of interest to disclose.

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