Catheter-directed thrombolysis in submassive pulmonary embolism: Safety and efficacy

Objective: The majority of trials for catheter-directed thrombolysis (CDT) in submassive pulmonary embolism (sPE) were done in a tertiary care setting. There is a need to assess the applicability of CDT for sPE in a community hospital setting. Methods: A retrospective chart review was performed from May 2017 to March 2019 to extensively evaluate patients with pulmonary embolism and patients who underwent CDT. An active multidisciplinary process between critical care, interventional cardiology, and interventional radiology facilitated this undertaking. Results: Of the 176 patients with PE, 13% (n=22) of patients who had computed tomography (CT) evidence of right ventricle (RV) strain and elevated cardiac biomarkers were assessed for the possibility of CDT. Of these 22 patients, 10 patients had CDT performed once, and one patient underwent CDT twice. The mean age of the CDT group was 53 years. Of patients in the CDT group, 81.8% (n=9) were female, and 54.5% (n=6) were Caucasian. The time between diagnosis of sPE to CDT was 0 to 3 days while risks and benefits were assessed. The most commonly used access site was femoral (n=5). Total duration of alteplase (tPA) ranged from 6 to 24 hours, with the majority of patients receiving 24 hours duration. The mean total dose was 23.5 mg, and the average length of hospital stay was 6 days. Seventy percent (n=7) of patients were discharged home without oxygen. Two patients were readmitted due to non-adherence with anticoagulation and drug interactions. No mortality or major bleeding was observed. Conclusion: Employing CDT in a community-based setting appears to be efficacious and safe.