Community Hospital Offers Catheter-Directed Pulmonary Thrombolysis

It amazes me that over many decades, the treatment of pulmonary embolism has remained stagnant. There have been no significant changes in the way we treat these patients. Most are treated with systemic anticoagulation and prolonged warfarin therapy.

There are many limitations to the use of systemic thrombolysis. The most important one is a high incidence of bleeding complications, about 20%-40%. Surgical thrombectomy also has limitations and is performed in a very limited number of centers, with mortality rates of about 10%-20%.

There is no question in my mind that there is a large potential benefit in treating patients with catheter-directed thrombolysis, particularly patients with massive pulmonary embolism. There’s also a potential benefit from catheter-directed thrombolysis in a large subgroup of patients with submassive pulmonary embolism. Those patients may benefit the most in terms of prevention of pulmonary hypertension.

Many of these questions are being investigated now in a European prospective, randomized trial comparing catheter-guided pulmonary thrombolysis to chemical thrombolysis. In the Unites States, there are a couple of registries for these patients, and a randomized trial is expected to start in the near future. I encourage vascular specialists to enroll patients in these.

Dr. Juan Ayerdi is a clinical assistant professor of vascular surgery at the Medical Center of Central Georgia, Macon. He made these remarks as the discussant of Dr. Wang’s presentation at the meeting. Dr. Ayerdi reported having no financial disclosures.