A recent study has compared postprocedural changes in hemoglobin following catheter-directed thrombolysis (CDL) versus large-bore aspiration thrombectomy (LBAT) of acute pulmonary embolism (PE). It was found that there was no significant difference in short-term (about 13–20 hours), postprocedural HGB change between CDL and LBAT regardless of the usage of an autotransfusion device (ATD). However, there was significantly lower estimated blood loss in the LBAT group using an ATD.
The results are detailed in Featured Abstract, “A Comparison of Post-Procedural Hemoglobin in Catheter-Directed Thrombolysis vs. Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism,” which will be presented on Monday, March 25, from 3–4:30 p.m. MT.
According to researchers, during a LBAT, there tends to be a higher estimated blood loss. Researchers sought to understand if that impacts the patient in any meaningful way, such as leading to longer hospitalization time or greater need for blood transfusions.
“There’s not a lot of literature comparing CDL to LBAT directly,” said lead author Jamil Ahmed, MD. “We’re comparing the difference between mechanical thrombectomy and catheter-directed thrombolysis, which are two fairly common interventions that hospitals around the country and the world use for treatment of PE.”
Dr. Ahmed and his team reviewed data from their institution, looking at the treatment of PE for patients who have intermediate- and high-risk PE. There were 166 patients in the CDL group (56±15 years). The LBAT group included patients treated without an ATD (LBAT, n=58, 61±16 years) and with an ATD (LBATw, n=47, 62±15 years). The age difference was significant (p=.01). The number of patients with intermediate-risk PE was 91.6%, 89.6% and 87.3% in the CDL, LBAT and LBATw groups, respectively (p=.2). The remaining patients in each group had high-risk PE.
“We looked at three groups,” said researcher Assaf Graif, MD. “One is the catheter that just melts away the clot; no aspiration involved. The second is the aspiration catheter. The third is the aspiration catheter with the auto transfusion device.”
According to Dr. Ahmed, they did find changes in estimated blood loss between the groups, but the initial analysis did not suggest that those contributed to any significant changes in need for transfusion between the groups. He also noted that the major adverse event rates between the groups were not significantly different either. Overall, no significant changes in hemoglobin levels were noted when comparing pre-procedure hemoglobin level to the first hemoglobin level taken post-procedure.
“You need to look at the bigger picture,” said Dr. Graif. “While the change in hemoglobin may be the same in all procedures or slightly higher in some procedures, although not significantly, the preprocedural hemoglobin comes into play.”
For example, Dr. Graif said, if an otherwise healthy patient presents with a PE, and has a hemoglobin of 15, the IR will have a multiple techniques and devices to choose from. "If you have a lot of leeway, then you can probably use whatever device you want without much issue. You can aspirate the clot, give blood back, not give it back, melt it, etc.” However, if the patient is more frail or ill, with a hemoglobin level of 8 or below, that limits options. “There’s less leeway for you to work with, so while these methods are similar, you might consider choosing a method that has less of a hemoglobin drop because you have less of a buffer zone,” Dr. Graif said.
Dr. Ahmed and Dr. Graif stated that any method is probably safe as long as you choose the right patient—a patient whose hemoglobin isn’t too low to begin with.
