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Tytuł:
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Catheter-Directed Therapy: Outcomes Versus Standard of Care and Evaluation of Current Practice.
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Autorzy:
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Zulty M; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD.
Saleh N; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD.
Hernandez J; Georgetown University School of Medicine, Washington, DC.
Kalaria A; Department of Radiology, MedStar Union Memorial Hospital, Baltimore, MD.
Camire L; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD.
Weisman DS; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD; Georgetown University School of Medicine, Washington, DC. Electronic address: .
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Źródło:
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The American journal of medicine [Am J Med] 2021 Mar; Vol. 134 (3), pp. 400-404. Date of Electronic Publication: 2020 Nov 02.
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Typ publikacji:
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Comparative Study; Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: New York, NY : Excerpta Medica
Original Publication: New York, Donnelly.
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MeSH Terms:
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Catheterization*
Standard of Care*
Vena Cava Filters*
Pulmonary Embolism/*therapy
Thrombolytic Therapy/*methods
Tissue Plasminogen Activator/*administration & dosage
Aged ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pulmonary Embolism/mortality ; Retrospective Studies ; Treatment Outcome
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Contributed Indexing:
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Keywords: Catheter-directed thrombolysis; Pulmonary embolism
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Substance Nomenclature:
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EC 3.4.21.68 (Tissue Plasminogen Activator)
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Entry Date(s):
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Date Created: 20201104 Date Completed: 20210317 Latest Revision: 20210317
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Update Code:
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20240105
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DOI:
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10.1016/j.amjmed.2020.09.045
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PMID:
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33144134
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Background: Small studies have noted benefit with the use of catheter-directed therapy (CDT) versus standard of care in treatment of pulmonary embolism, but none have focused on the variability of clinical practice with this modality.
Methods: International Classification of Diseases (ICD) codes were used to retrospectively identify consecutive adult patients admitted to an intensive care unit (ICU) with pulmonary embolism over a 2-year period. We evaluated inpatient mortality and major bleeding and assessed treatment variation.
Results: Of 284 patients included, 46 underwent CDT (9 massive pulmonary embolism, 37 submassive pulmonary embolism). Significantly more patients who underwent standard treatment had a history of congestive heart failure and diabetes. Obesity, higher troponin levels, and right heart strain were significantly more likely in the CDT group. No significant difference in inpatient mortality or major bleeding events was observed between the treatment groups. Tissue plasminogen activator use varied widely in the CDT group, and inferior vena cava filter utilization was significantly more common in the CDT group (18; 41%) compared with the standard group (40; 17%) (P < 0.01).
Conclusions: In this study, no significant difference in inpatient mortality or major bleeding was found in patients in the intensive care unit with pulmonary embolism who underwent CDT compared with standard care. It may be beneficial to standardize this procedure given the potential benefit of CDT in patients with submassive pulmonary embolism.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
