1Meenakshi College of Allied Health Sciences, Meenakshi Academy of Higher Education and Research
2Department of Pathology, Meenakshi Medical College Hospital and Research Institute, Meenakshi Academy of Higher Education and Research
3Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College and Hospital
4Meenakshi College of Nursing, Meenakshi Academy of Higher Education and Research
5Meenakshi College of Physiotherapy, Meenakshi Academy of Higher Education and Research
6Meenakshi College of Arts and Science, Meenakshi Academy of Higher Education and Research
Background: The findings which include intermediate-high-risk pulmonary embolism (PE) are that of right-ventricular (RV) strain and high cardiac biomarkers but hemodynamic stability. The management question is debatable, and the generic strategies in the management of anticoagulated that form the effective clot stabilization and the minimal rate of reinstating RV dysfunction. Catheter-guided thrombolysis (CDT) correlates with particular fibrinolysis and throughputs of quicker hemodynamic execution and reduced blood loss in contrast to systemic thrombolysis. However, the contemporary comparative statistics remains low.
Objective: To establish the clinical outcomes, catheter-directed thrombolysis and conventional anticoagulation in patients with intermediate-high risk PE which is different in terms of clinical outcomes, RV recovery and safety.
Method: It was a multicentric retrospective observer cohort trial participants had been recruited among 612 adults who had intermediate-high-risk PE during the period of 2018-2023. The CDT patients were treated with the use of low dose catheter-directed alteplase, and the controls were treated with the use of guideline directed anticoagulation alone. Primary outcome: 7-day change in the ratio of the RV/left-ventricular (LV) on the CT angiography or echocardiography. The in-hospital mortality, rescue reperfusion, and length of stay and major bleeding (based on ISTH criteria) were secondary outcomes. Propensity-score weighting was the result of balance of baseline characteristics.
Results: At 7 days of CDT, RV/LV ratio change was significantly more dramatic (-0.34 vs -0.18; p=0.001) and less rescue reperfusion (3.2 vs 9.7; p=0.01). The groups did not differ significantly in regard to in-hospital mortality (2.1 and 3.4; p=0.28). There was observed significant hemorrhage among 4.5 percent of the patients on CDT compared to 2.8 percent on anticoagulation (p=0.18).
Conclusion: Catheter-directed thrombolysis where intermediate-high-risk PE is concerned provides a superior recovery of the RV in the early state of time and reduces the requirement of also therapy by the rescue method, however, there are not significant reduction in significant hemorrhage. The results support the use of the CDT among patients in a focused approach as it should be confirmed randomly and prospectively.
Keywords: Pulmonary embolism, anticoagulation, RV/LV ratio, rescue reperfusion, thrombolytic therapy.
How to cite this article: Ramnath V, Aishwarya, Logeswari J, Dhanraj FM, Parthasarathy R, Thilagavathi T. Catheter-Directed Thrombolysis vs Anticoagulation in Intermediate-High-Risk Pulmonary Embolism: A Contemporary Comparison. Int J Drug Deliv Technol. 2026;16(10s): 120-126; DOI: 10.25258/ijddt.16.10s.17
Source of support: Nil.
Conflict of interest: None