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Catheter-Directed Therapy: Outcomes vs Standard of Care and Evaluation of Current Practice.

by Camire, Lyn; Kalaria, Amit; Saleh, Nahar; Weisman, David S; Zulty, Mary.
Citation: American Journal of Medicine. 134(3):400-404, 2021 03.; .Journal: The American journal of medicine.Published: 2021; ; ; ISSN: 0002-9343.Full author list: Camire L; Hernandez J; Kalaria A; Saleh N; Weisman DS; Zulty M.UI/PMID: 33144134.Subject(s): *Catheterization | *Pulmonary Embolism/th [Therapy] | *Standard of Care | *Thrombolytic Therapy/mt [Methods] | *Tissue Plasminogen Activator/ad [Administration & Dosage] | *Vena Cava Filters | Aged | Female | Hospital Mortality | Humans | Male | Middle Aged | Pulmonary Embolism/mo [Mortality] | Retrospective Studies | Treatment OutcomeInstitution(s): MedStar Good Samaritan Hospital | MedStar Union Memorial HospitalActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.amjmed.2020.09.045 (Click here) Abbreviated citation: Am J Med. 134(3):400-404, 2021 03; .Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present.Abstract: BACKGROUND: Small studies have noted benefit with use of catheter-directed therapy (CDT) versus standard of care in treatment of pulmonary embolism, but none have focused on the variability of clinical practice with this modality.Abstract: CONCLUSIONS: In this study, no significant difference in inpatient mortality or major bleeding was found in ICU pulmonary embolism patients who underwent CDT compared with standard care. It may be beneficial to standardize this procedure, given the potential benefit of CDT in patients with submassive pulmonary embolism. Copyright (c) 2020. Published by Elsevier Inc.Abstract: METHODS: ICD codes were used to retrospectively identify consecutive adult patients admitted to an intensive care unit (ICU) with pulmonary embolism over a 2-year period. We evaluated inpatient mortality and major bleeding and assessed treatment variation.Abstract: RESULTS: Of 284 patients included, 46 underwent CDT (9 massive pulmonary embolism, 37 submassive pulmonary embolism). Significantly more patients who underwent standard treatment had a history of congestive heart failure and diabetes. Obesity, higher troponin levels, and right heart strain were significantly more likely in the CDT group. No significant difference in inpatient mortality or major bleeding events was observed between the treatment groups. Tissue plasminogen activator use varied widely in the CDT group, and inferior vena cava filter utilization was significantly more common in the CDT group (18; 41%) compared to the standard group (40; 17%) (p <0.01).

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