(8790) Factors Associated With Bleeding After Catheter-Directed Thrombolysis for Pulmonary Embolism

Introduction: Ultrasound-assisted catheter directed thrombolysis (US-CDT) is frequently used for treatment of pulmonary embolism (PE). Although it is perceived that the benefit of US-CDT outweighs the risks, there are no robust comparisons to alternative therapies. Due to the variety of thrombolytic and anticoagulant dosing utilized in practice, patients with PE who undergo US-CDT may be at an increased risk of bleeding. The primary objective of this study was to determine factors associated with major bleeding occurring with US-CDT. Secondary outcomes included in-hospital mortality and ventilator-free days.

METHODS : This multicenter retrospective cohort study evaluated inpatients from four United States medical centers who were diagnosed with PE and treated with US-CDT and systemic anticoagulation.

Results: A total of 173 patients were included. Most patients receiving US-CDT had a submassive PE with a median Pulmonary Embolism Severity Index (PESI) score of 85. Major bleeding events occurred in 37 of the 173 patients (21%). In-hospital mortality occurred in four (11%) of the patients who experienced major bleeding and three (2%) patients who did not experience major bleeding (p = 0.04). Factors associated with a higher risk of major bleeding included female sex and anticoagulation strategy. The odds of major bleeding were 3.3 times higher for females compared to males (OR = 3.32, 95% CI 1.29, 8.54). Additionally, for each second increase in goal aPTT the odds of major bleeding increased by 5% (OR = 1.05, 95% CI 1.02, 1.09).

Conclusions: In patients with PE treated with US-CDT, major bleeding may be under estimated. In this analysis, major bleeding was associated with female sex and higher goal aPTT levels. Additionally, bleeding with US-CDT was associated with a higher risk of in-hospital mortality.