Abstract 13017: National Characteristics and Outcomes of Adults With Pulmonary Embolism Undergoing Catheter Directed Thrombolysis Compared to Systemic Tissue Plasminogen Activator

Introduction: Catheter Directed Thrombolysis (CDT) and systemic tissue plasminogen activator (tPA) are commonly used interventions for pulmonary embolism (PE). We aim to compare these two procedures.

Methods: Cases of pulmonary embolism in adults were used for our study from the National Inpatient Sample (2016-2020). We compared the characteristics and outcomes of patients undergoing CDT vs. systemic tPA <24 hours after hospitalization.

Results: We found 16675 cases of PE, with 9130 (54.8%) patients undergoing tPA and 7545 (45.2%) needing CDT. Compared to tPA cases, a lower rate of weekend admission was seen in patients undergoing CDT. Both groups consisted of Whites and were covered primarily by Medicare. Most admissions took place in urban teaching centers, with large bed sizes and in the southern regions of the US. Furthermore, CDT patients were older (mean age 56.2 vs. 52.1 years), involving more patients with hypertension and obesity. However, CDT cases had fewer patients with diabetes, peripheral vascular disease, chronic kidney disease, prior stroke, and drug abuse and reported a lower mean Charlson Comorbidity Index(CCI) score(table 1). tPA patients also had higher rates of atrial fibrillation, ventricular fibrillation, and atrial flutter. Overall, 5.9% of patients undergoing tPA died, while 1.8% died in the CDT cohort (aOR death in tPA 2.604 vs. CDT, 95% CI 2.033-3.335, p<0.01). A higher mortality rate within the first week of hospitalization was also seen in the tPA group (figure 1). tPA cohort also reported higher odds of acute kidney injury(AKI) (aOR 1.484, 95% CI 1.364-1.615, p<0.01) and cardiogenic shock (aOR 3.588, 95% CI 2.990-4.304, p<0.01). Finally, tPa patients had a lengthier stay.

Conclusions: CDT cases showed lower mortality during the first week of the procedure. Differences in comorbidities exist between the two groups. Further research exploring additional factors may help address current protocols to improve long-term outcomes.