Premium
Utilization of catheter‐directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter‐directed thrombolysis
Author(s) -
Patel Nish,
Patel Nileshkumar J.,
Agnihotri Kanishk,
Panaich Sidakpal S.,
Thakkar Badal,
Patel Achint,
Savani Chirag,
Patel Nilay,
Arora Shilpkumar,
Deshmukh Abhishek,
Bhatt Parth,
Alfonso Carlos,
Cohen Mauricio,
Tafur Alfonso,
Elder Mahir,
Mohamed Tamam,
Attaran Ramak,
Schreiber Theodore,
Grines Cindy,
Badheka Apurva O.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26108
Subject(s) - medicine , thrombolysis , interquartile range , pulmonary embolism , hazard ratio , propensity score matching , fibrinolytic agent , confidence interval , antithrombotic , myocardial infarction
Objective 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). Background Contemporary real world data regarding utilization and outcomes comparing systemic thrombolysis with CDT for PE is sparse. Methods 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). Results 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. Conclusions CDT was associated with lower in‐hospital mortality and combined in‐hospital mortality and ICH. © 2015 Wiley Periodicals, Inc.