Abstract Number: PB2404
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Intermediate-high risk pulmonary embolism (PE), with hemodynamic stability and evidence of right ventricular dysfunction, is common and treatment is controversial. Whether therapy more aggressive than anticoagulation alone improves outcomes remains uncertain. We report our experience with intermediate-high risk PE (ESC 2019 definition) utilizing our multidisciplinary PE Response Team).
Aims:
1. To present intermediate-high risk PE treated with different approaches and report outcomes.
2. To see whether specific clinical factors correlate with therapeutic decisions.
Methods: Retrospective case series of patients treated between 2017-2019, evaluating clinical and laboratory parameters at time of diagnosis. Chi-square testing was used for discrete variables and one-way ANOVA for continuous variables.
Results: A total of 472 patients were treated by the PE Response Team, of which 110 were intermediate-high risk. A comparison of patients treated with anticoagulation alone versus anticoagulation plus additional PE-specific therapy (specified in Table 1) may be found in Table 2. All-cause mortality was 10%. Progression to massive PE was seen in 2.7% of patients. There was no statistical difference in any outcome between patients treated with anticoagulation alone and those treated with a PE-specific therapy. Patients were more likely to be treated with anticoagulation alone if they were older (p< 0.01) or had a lower heart rate (p=0.01). While patients treated with PE-specific therapy did have higher biomarkers, these were not statistically significant between groups.
Conclusions: We found no statistical difference in survival to discharge or progression to massive PE between patients treated with anticoagulation alone and patients treated with anticoagulation plus a PE-specific therapy. Patients appeared to be more likely to receive aggressive therapy if they were younger or had higher heart rate.
| Type of therapy | N, % |
| Anticoagulation alone | 59, 54 |
| Catheter-directed thrombolysis | 20, 18.2 |
| Aspiration thrombectomy | 19, 17.3 |
| Surgical embolectomy | 1, 0.9 |
| Full-dose tPA | 5, 4.5 |
| Half-dose tPA | 5, 4.5 |
| Quarter-dose tPA | 2, 1.8 |
| More than 1 intervention | 12, 24 |
[Type of PE-specific therapy used]
| Anticoagulation alone | Anticoagulation + PE specific treatment | p-value | |
| N | 59 | 51 | |
| Age (mean, SD) | 70.7, 17.1 | 57.5, 15.6 | <0.01 |
| Alive at discharge (%) | 55 (93) | 47 (92) | 0.76 |
| Death unrelated to PE (%) | 6 (10) | 1 (2) | ” “ |
| Death related to PE (%) | 1 (1.7) | 3 (6) | ” “ |
| Max heart rate (mean, SD) | 106, 19.7 | 116, 20.1 | 0.01 |
| Peak troponin (ng/mL; mean, SD) | 0.66, 1.6 | 0.9, 2.2 | 0.51 |
| BNP (pg/mL; mean, SD) | 568, 703.6 | 656, 1070.1 | 0.62 |
| D-dimer (ug/mL; mean, SD) | 10.1, 7.5 | 12.3, 7.7 | 0.31 |
[Biomarkers and outcomes compared between type of therapies used]
To cite this abstract in AMA style:
Matusov Y, Weinberg A, Friedman O, Tapson V. Management of Intermediate-High Risk Pulmonary Embolism Utilizing a PE Response Team [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/management-of-intermediate-high-risk-pulmonary-embolism-utilizing-a-pe-response-team/. Accessed May 16, 2022.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-intermediate-high-risk-pulmonary-embolism-utilizing-a-pe-response-team/