Abstract 12481: Comparative Outcomes of Catheter Directed Thrombolysis Plus Systemic Anticoagulation versus Systemic Anticoagulation Alone in the Management of Intermediate-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis

Introduction: There are limited and conflicting data on the initial management of intermediate-risk (or submassive) pulmonary embolism (PE).

Hypothesis: This study sought to compare outcomes of catheter directed thrombolysis (CDT) in combination with systemic anticoagulation (SA) to SA alone.

Methods: A systematic search was conducted in MEDLINE, EMBASE, PubMed, and the Cochrane databases from inception to March 1, 2023 for studies comparing outcomes of CDT+SA versus SA alone in intermediate-risk PE. The major outcomes were in-hospital, 30-day, 90-day, and 1 year mortality, minor and major bleeding, and blood transfusion, right ventricular (RV) recovery, and length of stay (LOS). We used random-effects models to aggregate data and to calculate pooled incidence and risk ratios (RR) with 95% confidence intervals (CIs).

Results: A total of 15 (two randomized, 13 observational) studies with 10,549 (2,310 CDT+SA and 8,239 SA alone) patients were included. Compared with SA, CDT+SA was associated with significantly lower in-hospital mortality (RR 0.41, 95% CI 0.30 to 0.56, p <0.001), 30-day mortality (RR 0.34, 95% CI 0.18 to 0.67, p =0.002), 90-day mortality (RR 0.34, 95% CI 0.17 to 0.67, p =0.002), and 1-year mortality (RR 0.58, 95% CI 0.34 to 0.97, p =0.04). There were no significant differences between the two cohorts in rates of major bleeding (RR 1.39, 95% CI 0.72 to 2.68, p =0.56), minor bleeding (RR 1.83, 95% CI 0.97 to 3.46, p =0.06), and blood transfusion (RR 0.34, 95% CI 0.10 to 1.15, p =0.08).

Conclusions: CDT+SA is associated with significantly lower short-term and long-term all-cause mortality without any differences in major/minor bleeding, in patients with intermediate-risk PE.