REGULAR CONTENT
Final ID
415
Type
Original Scientific Research-Oral or Pos
Authors
D Chawala1, B Taslakian2, A Sista2
Institutions
1Weill Cornell Medicine, New York, NY, 2NYU Langone Medical Center, New York, NY
Purpose
Submassive pulmonary embolism (PE), characterized by right ventricular (RV) dysfunction but normal hemodynamics, represents >25% of PE cases and carries 3% mortality and 5% rate of clinical deterioration. Despite this high prevalence, the optimal therapy for submassive PE is unknown because advanced therapies carry significant risks and uncertain benefits. While some employ systemic thrombolysis (ST) or catheter-directed thrombolysis (CDT) frequently, others treat submassive PE with anticoagulation alone. We conducted a national survey to assess practice patterns among physicians who manage submassive PE.
Materials & Methods
From July-August 2016, 83 sites were invited to participate in an online survey which included 7 different submassive PE scenarios. Endovascular and medical providers ranked on a scale of 1-5 their predilection towards CDT. A score of 3 ('possibly'), 4 ('probably yes'), or 5 ('always') indicated a predilection towards CDT. They also indicated whether they would consider ST ('Yes' or' No').
Results
Endovascular and medical specialists from 60 sites completed the survey. Across all scenarios, endovascular specialists favored CDT (mean score 3.5; 95% CI:3.4-3.6) and demonstrated a significantly higher predilection for CDT over their medical colleagues (mean 3.0; 95% CI: 2.9-3.1), p<0.0001. Also, a higher percentage of physicians preferred CDT (73.5%; 95% CI:70.5-76.5%) compared to ST (5.3%; 95% CI: 3.8-6.8%), with statistically significant differences among medical and endovascular specialists (table).
Conclusions
The results of our survey suggest that CDT is frequently considered by physicians who manage submassive PE. While CDT's ability to lyse thrombus and restore pulmonary blood flow and RV function is documented, its safety and effectiveness have not been robustly established. The predilection towards CDT demonstrated by our data re-affirms the importance of conducting well-powered randomized trials of CDT with clinical endpoints.
Final ID
415
Type
Original Scientific Research-Oral or Pos
Authors
D Chawala1, B Taslakian2, A Sista2
Institutions
1Weill Cornell Medicine, New York, NY, 2NYU Langone Medical Center, New York, NY
Purpose
Submassive pulmonary embolism (PE), characterized by right ventricular (RV) dysfunction but normal hemodynamics, represents >25% of PE cases and carries 3% mortality and 5% rate of clinical deterioration. Despite this high prevalence, the optimal therapy for submassive PE is unknown because advanced therapies carry significant risks and uncertain benefits. While some employ systemic thrombolysis (ST) or catheter-directed thrombolysis (CDT) frequently, others treat submassive PE with anticoagulation alone. We conducted a national survey to assess practice patterns among physicians who manage submassive PE.
Materials & Methods
From July-August 2016, 83 sites were invited to participate in an online survey which included 7 different submassive PE scenarios. Endovascular and medical providers ranked on a scale of 1-5 their predilection towards CDT. A score of 3 ('possibly'), 4 ('probably yes'), or 5 ('always') indicated a predilection towards CDT. They also indicated whether they would consider ST ('Yes' or' No').
Results
Endovascular and medical specialists from 60 sites completed the survey. Across all scenarios, endovascular specialists favored CDT (mean score 3.5; 95% CI:3.4-3.6) and demonstrated a significantly higher predilection for CDT over their medical colleagues (mean 3.0; 95% CI: 2.9-3.1), p<0.0001. Also, a higher percentage of physicians preferred CDT (73.5%; 95% CI:70.5-76.5%) compared to ST (5.3%; 95% CI: 3.8-6.8%), with statistically significant differences among medical and endovascular specialists (table).
Conclusions
The results of our survey suggest that CDT is frequently considered by physicians who manage submassive PE. While CDT's ability to lyse thrombus and restore pulmonary blood flow and RV function is documented, its safety and effectiveness have not been robustly established. The predilection towards CDT demonstrated by our data re-affirms the importance of conducting well-powered randomized trials of CDT with clinical endpoints.