The use of thrombolytic therapy in a multidisciplinary pulmonary embolism response team

• Main Authors: Anders Kramer, Christian Schmidt Mortensen, Jacob Gammelgaard Schultz, Nicholas Giordano, Hui Zheng, Asger Andersen, Jens Erik Nielsen-Kudsk, Christopher Kabrhel
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: Thrombosis Update
• Subjects: Pulmonary embolism; Venous thromboembolism; Thrombolysis; Rapid response team; Thrombosis
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666572721000055

Introduction: The implementation of a pulmonary embolism response team (PERT) is associated with an increase in the use of thrombolysis, in particular, catheter-directed thrombolysis (CDT). Expert multidisciplinary PERTs may use thrombolysis outside of guideline recommendations, but the clinical characteristics of patients treated with thrombolysis by PERT clinicians are not well described. Materials and methods: This study was based on all confirmed pulmonary embolism (PE) patients within the MGH PERT database as of January 1st, 2019. Patients were stratified according to treatment strategy and divided into patients having received any thrombolytic treatment (AT), CDT, intravenous thrombolysis (IVT) or no clot reducing therapy (NCR). Data were extracted on demographics, symptoms, medical history, clot burden, right heart strain, biochemistry and operational characteristics. Furthermore, patients were risk-stratified according to ESC guidelines. Univariate analyzes were performed for three different comparisons; AT vs NCR, CDT vs NCR and CDT vs IVT. Results: Among confirmed PE patients, 109/831 (13.1%) underwent thrombolytic therapy. Thrombolysis was divided between 74 (8.9%) CDT and 35 (4.2%) IVT. Central clot burden (p ​< ​0.001), right heart strain (p ​< ​0.001), and abnormal vital signs (p ​< ​0.001) were strongly correlated to thrombolytic therapy. CDT was favored over IVT in patients within the ESC intermediate-high risk category (p ​< ​0.001), with central thrombus (p ​= ​0.028) and during weekdays (p ​= ​0.028). Conclusions: In this retrospective analysis, we identified several factors associated with the choice of treatment within the MGH PERT program. These data may be useful in understanding how patients are chosen for thrombolysis and whether different thrombolytic approaches improve outcomes in PE.