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Catheter-Directed Thrombolysis for Patients with Intermediate-high-risk Pulmonary Embolism: Is It Safe and Effective?

Abdelmaksoud A Elganady, Abeer M Shawky and Ahmed Dawood

Background: Intermediate-high-risk Pulmonary Embolism (PE) is common and carries a risk of progression to hemodynamic collapse and death. Catheter-Directed Thrombolysis (CDT) has become a recommended treatment option in intermediate-high-risk PE. For such cases, CDT ensures recovery of echocardiographic and haemodynamic parameters and may be characterized by a better safety profile. We aimed to clarify the effectiveness of CDT in improving the short term disease-outcomes without increasing the risk of bleeding in intermediate-high-risk PE. Methods and Results: This is a single-centre retrospective observational study of consecutive fifty patients with a mean age of 55+04 with a primary diagnosis of sub massive PE with high-risk features, admitted to an intensive care unit between November 2018 and April 2020. We identified patients with intermediate-high-risk PE to be treated with CDT of Tissue Plasminogen Activator (tPA), by our Pulmonary Embolism Response Team (PERT). We compared the outcome of patients before and after treatment with CDT. There was a significant improvement in symptoms and a decrease in laboratory markers of myocardial injury (proBNP and Troponin-T). Also, comparing baseline echocardiographic parameters including RV:LV ratio, RV-TAPSE and sPAP with the same parameters after completion of CDT revealed a significant reduction in these parameters with improvement in right ventricular function. There were no in-hospital deaths secondary to haemorrhage or procedure-related complications in the studied patients. During the follow-up range of three months after CDT, only 3 minor bleeding episodes were encountered but no hemodynamic decompensation, recurrent venous thromboembolism, major bleeding complications or death. Conclusion: CDT can be used in patients with intermediated-high-risk PE safely and effectively. Future studies will further define the role of CDT in comparison to other revascularization strategies in the management of PE patients at increased risk.