Meta-Analysis of Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Pulmonary Embolism.

BACKGROUND: Studies have shown variable outcomes regarding catheter-based mechanical thrombectomy (MT) versus catheter-directed thrombolysis (CDT) in patients with pulmonary embolism (PE). We conducted a meta-analysis of the available data. METHODS: Online databases were searched for studies comparing MT and CDT for PE. The outcomes of interest were procedure time (minutes), fluoroscopy duration (minutes), estimated blood loss (ml), change in mean pulmonary arterial pressure (mPAP, mmHg), change in right ventricle (RV)/left ventricle (LV) ratio, postprocedural intensive care unit (ICU) admission, ICU length of stay (days), hospital length of stay (days), intracranial hemorrhage (ICH), major bleeding, all-cause mortality, PE-related readmission and all-cause readmission. Pooled odds ratios (OR) and standardized mean difference (SMD), along with 95% confidence intervals (CI) were calculated. RESULTS: A total of 10 studies (1842 patients-852 [MT], 990 [CDT]) were included. The follow up duration varied from in-hospital to 1 year. Mean age was 62 years and 49% of patients were men. As compared to the CDT group, patients undergoing MT had longer procedure time (SMD 6.04, 95% CI 2.46 to 9.62, p = 0.0010), fluoroscopy duration (SMD 1.77, 95% CI 0.84 to 2.71, p = 0.0002), and greater estimated blood loss (SMD 1.56, 95% CI 0.52 to 2.60, p = 0.003), with lower postprocedural ICU admission rate (OR 0.01, 95% CI 0.00 to 0.02, p < 0.00001) and ICU length of stay (SMD -0.53, 95% CI -0.91 to -0.15, p = 0.007). No significant differences were found with respect to changes in mPAP and RV/LV ratio, hospital length of stay, ICH, major bleeding, all-cause mortality, PE-related readmission and all-cause readmission. CONCLUSION: While CDT is faster and associated with lesser blood loss in patients with PE, the ICU admission rate and length of stay is significantly greater with CDT than MT.

Duke Scholars

Author Paul Alfred Gurbel Medicine, Clinical Pharmacology