A Meta-analysis of Standard Versus Ultrasound-Assisted Catheter-Directed Thrombolysis in the Management of Acute Pulmonary Embolism

Authors

Elizabeth S. Bruno
Mark Terence P. Mujer
Parth V. Desai
Yevgeniy Brailovsky, Thomas Jefferson UniversityFollow
Amir Darki

Document Type

Article

Publication Date

1-1-2023

Comments

This article is the author's final published version in Journal of the Society for Cardiovascular Angiography and Interventions, Volume 2, Issue 1, January 2023, Article number 100514.

The published version is available at https://doi.org/10.1016/j.jscai.2022.100514.

Copyright © 2022 The Author(s). Published by Elsevier Inc. on behalf of the Society for Cardiovascular Angiography and Interventions Foundation.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract

Background: Standard catheter-directed thrombolysis (SCDT) harnesses the therapeutic benefit of systemic thrombolytics while minimizing bleeding complications in patients presenting with pulmonary embolism (PE). Ultrasound-assisted catheter-directed thrombolysis (USAT) theoretically improves upon SCDT by disrupting fibrin and increasing the surface area exposed to thrombolytic agent. However, it is unclear if this translates into improved outcomes.

Methods: A systematic search of prior publications comparing SCDT and USAT in patients with intermediate or high-risk PE was conducted. Primary outcomes of interest were bleeding events, ICU and hospital length of stay. Secondary outcomes included changes in pulmonary artery systolic pressure (PASP), mean pulmonary artery pressure (mPAP), and right ventricle to left ventricle diameter (RV/LV) ratio. Studies that lacked comparison groups were excluded. Bias assessments were performed using the Cochrane tools for randomized and nonrandomized studies. Data was collated utilizing the Cochrane Review Manager software, and all analyses assumed random effects.

Results: Our search yielded 7 observational studies and 1 randomized control trial. The studies included a total of 543 patients who underwent either SCDT (n = 273) or USAT (n = 270) for intermediate or high-risk PE. The synthesized analysis showed no significant differences in bleeding between the groups. There were no differences in ICU or hospital lengths of stay, changes in PASP, or mPAP. Reductions in RV/LV ratio were greater with SCDT (mean difference, −0.16; 95% CI, −0.27 to −0.06; P =.003).

Conclusions: In comparison to SCDT, USAT did not result in improved clinical or hemodynamic outcomes in patients presenting with PE.

Recommended Citation

Bruno, Elizabeth S.; Mujer, Mark Terence P.; Desai, Parth V.; Brailovsky, Yevgeniy; and Darki, Amir, "A Meta-analysis of Standard Versus Ultrasound-Assisted Catheter-Directed Thrombolysis in the Management of Acute Pulmonary Embolism" (2023). Division of Cardiology Faculty Papers. Paper 130.
https://jdc.jefferson.edu/cardiologyfp/130

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Language

English