OR11-4
Comparative Outcomes of Mechanical Thrombectomy vs Contemporary Treatments Modalities for Intermediate and High-Risk Pulmonary Embolism: A Systematic Review and Metanalysis.
Presenter
Ruth Ann Mathew Kalathil, MD, CHI Health Creighton University Medical Center - Bergan Mercy, Omaha, NE
Ruth Ann Mathew Kalathil, MD1, Akshay Machanahalli Balakrishna, MD2, Dr. Hasaan Ahmed, MD3, Suma Pusapati1 and Ahmed Aboeata, MD2, (1)CHI Health Creighton University Medical Center - Bergan Mercy, Omaha, NE, (2)Creighton University School of Medicine, Omaha, NE, (3)CHI Health Creighton University Medical Center, La Canada Flintridge, CA
Keywords: Pulmonary Embolism (PE) and Venous Disease
Background:
Current evidence on interventional management of Pulmonary embolism (PE) is limited by scarcity in randomized trials (RTs). We sought to compare the safety outcomes of mechanical thrombectomy (MT) with other existing treatment strategies for intermediate and high-risk PE.
Methods:
A systematic search was conducted in PubMed, Google Scholar, and Cochrane databases. We identified patients who received mechanical thrombectomy (MT) and those with other contemporary treatments (including systemic thrombolysis, anticoagulation alone, catheter-directed thrombolysis, and surgical thrombectomy) in intermediate and high-risk PE. Our outcomes were all-cause in-hospital mortality, incidence of intracranial hemorrhage, major bleeding, need for blood transfusion, and hospital length of stay (LOS). Random-effect models were used to aggregate data and calculate pooled incidence and risk ratios with 95% confidence intervals (CIs).
Results:
Of a total of 285 studies,10 were included, comprising 11,131 patients. Similar outcomes were noted in all-cause in-hospital mortality [RR 0.49 (0.23-1.05); p = 0.07], major bleeding [RR 0.77 (0.37-1.59); p = 0.47], blood transfusion [RR 1.27 (0.77- 2.11) p = 0.35], intracranial hemorrhage [RR 0.48 (0.08-2.86) p = 0.42] and hospital LOS [mean difference -0.92 (-3.77-1.93) p = 0.53]. There was a non-statistical trend towards lower in-hospital mortality after MT.
Conclusions:
When comparing MT with other contemporary treatments for intermediate and high-risk PE, MT was noted to have similar in-hospital safety outcomes. RTs are needed to guide the optimal reperfusion strategy in this patient population. 