A Comparison of Postprocedural Hemoglobin in Catheter-Directed Thrombolysis versus Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism.

PURPOSE

To compare changes in hemoglobin (HB) following catheter-directed thrombolysis (CDT) versus large-bore aspiration thrombectomy (LBAT) of acute pulmonary embolism (PE).

MATERIALS AND METHODS

A single-center retrospective review of patients with acute high- or intermediate-risk PE treated with CDT or LBAT between December 2009 and September 2023 was performed. The LBAT group was divided according to usage of an autotransfusion device (ATD). There were 166 patients in the CDT group (56 years ± 15). LBAT patients were treated without (LBAT, n = 58, 61 years ± 16) or with (LBATw, n = 47, 62 years ± 15) an ATD. Endpoints included change in HB between preprocedural and postprocedural measurements, the 7-day postprocedural nadir (low point), and adverse events (AEs).

RESULTS

The mean HB changes between preprocedural and postprocedural measurements in the CDT, LBAT, and LBATw groups were -1.3 g/dL ± 1.3, -1.6 g/dL ± 0.98, and -1.1 g/dL ± 0.9, respectively (P = .098). The mean HB changes to the 7-day postprocedural nadir in the CDT, LBAT, and LBATw groups were -1.7 g/dL (SD ± 1.4), -2.4 g/dL (SD ± 1.3), and -1.8 g/dL (SD ± 1.3), respectively (P = .008). The minor hemorrhagic AE rates were 3.6% in the CDT group, 12.1% in the LBAT group, and 14.9% in the LBATw group (P = .010). There was no significant difference in moderate (P = .079) and major (P = .529) hemorrhagic AEs between the groups. There were no procedure-related mortalities.

CONCLUSIONS

The use of LBAT without ATD resulted in a significant decrease in HB to the 7-day postprocedural nadir compared with CDT or LBAT with ATD. This did not translate into significantly higher transfusion rates or moderate or major hemorrhagic events. Findings suggest that the decision between CDT and LBAT should not be based solely on the expected blood loss consideration.