Impact of Ultrasonic Fragmentation On Clinical Outcomes And Resource Utilization in Catheter-Directed Thrombolysis for Acute Pulmonary Embolism
Presenter
Aditya Mantha, M.D., Cleveland Clinic Main Campus, Cleveland, OH
Aditya Mantha, M.D., Cleveland Clinic Main Campus, Cleveland, OH, Akash Rusia, M.D., Beaumont Health, Royal Oak, MI, Sati Patel, M.D., Henry Ford Hospital, Detroit, IL, Shawn Shah, M.D., University Of Southern California, Los Angeles, CA and Anilkumar O. Mehra, M.D., The University of Southern California, Los Angeles, CA
Keywords: Complications, Pulmonary Embolism (PE) and Venous Disease
Background
Catheter-directed thrombolysis (CDT) has emerged as an effective alternative to systemic thrombolysis (ST) for acute pulmonary embolism (PE). However, the impact of ultrasonic fragmentation (US-CDT) on acute clinical outcomes and resource utilization remains less clear. Methods
Patients primarily admitted for pulmonary embolism (PE) in the 2016-2018 National Inpatient Sample (NIS) were identified using ICD-10 codes. The NIS is an all-payer survey-weighted inpatient database estimating 37 million annual U.S. hospitalizations. Patients admitted for STEMI, limb ischemia, and stroke were excluded. Primary study outcomes were mortality, hemorrhagic complications, and cost of care. Results
Of 548,975 patients with acute PE, 13,730 underwent ST and 20,305 received CDT of which 4,540 used US-CDT. CDT patients were on average 59.8 years, 47.5% female and 73% white race. US-CDT patients did not significantly differ in age, gender, or race. Adoption of US-CDT remained consistent from 2016 to 2018 (23.2% vs 24.1%, P=0.25). US-CDT had significantly lower adjusted mortality (2.6% vs 4.8%, aOR:0.54, P<0.01) than CDT alone. There was no difference in rate of hemorrhagic stroke, gastrointestinal hemorrhage or mechanical ventilation between US-CDT and CDT cohorts. Similarly the cost of care ($26,879 vs $27,479, eᵝ-1=0.02 P=0.22) and length of stay ( β=-0.05, P=0.07) of US-CDT was comparable to CDT. Conclusions
The use of mechanical thrombolysis with ultrasound significantly improves the mortality reduction observed with CDT in comparison to ST after multivariable adjustment without an increase in cost or length of stay. This study supports the adoption of US-CDT for acute pulmonary embolism in community practice.