Bankstown Hospital - Grand Rounds - Further Reading

Welcome to the Grand Rounds Further Reading List, Haematology edition, brought to you by the Clinical Library, on Level 4, next to the Auditorium.

This library guide is to help support you in your professional development. Please give us feedback so we can improve this list in the future.

If you have any questions, please contact the Clinical Library on 9722 8250 or email SWSLHD-BankstownLibrary@health.nsw.gov.au or visit us Monday to Fridays, 8.30am - 5.00pm.

DVT and

PE Thrombectomy

Afridi, A., et al. (2025). "Comparing mechanical thrombectomy and catheter directed thrombolysis for pulmonary embolism: A systematic review and meta-analysis." The American Journal of Emergency Medicine 95: 209-219 https://www.sciencedirect.com/science/article/pii/S0735675725004206  REQUEST ARTICLE

Purpose: Pulmonary embolism (PE) is a critical condition requiring prompt intervention. Mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT) are emerging catheter-based therapies, but their comparative effectiveness remains uncertain, particularly given the predominance of observational studies. Methods We conducted a systematic review and meta-analysis of studies identified through PubMed, Embase, and Web of Science from inception to February 10, 2025. Both randomized controlled trials and observational studies were included. Random-effects models were used for all analyses to account for anticipated heterogeneity. Primary outcomes were all-cause mortality, all-cause readmission, and PE-related readmission. Secondary outcomes included hospital stay, procedural time, and safety events. Heterogeneity was assessed using the I2 statistic. Results This meta-analysis included one randomized controlled trial (RCT) and six observational studies, comprising a total of 1369 patients (MT = 659, CDT = 710). MT was associated with a statistically significant reduction in hospital stay compared to CDT (Mean Difference = −0.47 days, 95 % CI: [−0.89, −0.05]; p = 0.03, I2 = 0 %). However, there were no significant differences between MT and CDT in terms of all-cause mortality (RR = 1.24, 95 % CI: [0.47, 3.30]; p = 0.66, I2 = 26 %), all-cause readmission (RR = 0.84, 95 % CI: [0.29, 2.41]; p = 0.75, I2 = 54 %), or PE-related readmission (RR = 0.64, 95 % CI: [0.13, 3.23]; p = 0.59, I2 = 0 %). Similarly, no significant differences were observed in procedural time (Mean Difference = 21.48 min, 95 % CI: [−5.20, 48.15]; p = 0.11, I2 = 95 %), fluoroscopy time (Mean Difference = 6.63 min, 95 % CI: [−3.14, 16.41]; p = 0.18, I2 = 93 %), or ICU stay (Mean Difference = −6.45 days, 95 % CI: [−20.25, 7.36]; p = 0.36, I2 = 100 %). Conclusion Current evidence, primarily from observational studies, suggests that MT and CDT offer comparable clinical outcomes in PE management, with MT potentially associated with a shorter hospital stay. However, given the limitations inherent to the available data, including study design and heterogeneity, these findings should be interpreted cautiously. Further high-quality randomized trials are needed to draw definitive conclusions.

Cavallino, C., et al. (2024). "Novel Challenges and Therapeutic Options for Pulmonary Embolism and Deep Vein Thrombosis." J Pers Med 14(8) https://pmc.ncbi.nlm.nih.gov/articles/PMC11355608/ PDF AT LINK

                Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment options in the management of acute PE and DVT, encompassing both established and emerging technologies, such as catheter-directed thrombolysis, aspiration thrombectomy, and other endovascular techniques. A comprehensive literature review was conducted, assessing clinical studies, trials, and case reports that detail the use of percutaneous interventions for PE and DVT and analyzing the advantages and disadvantages of each percutaneous system. Several percutaneous treatments have shown promising results, especially in cases where rapid thrombus resolution is critical, such as in high- and intermediate-high-risk patients. The incidence of major complications, such as bleeding, remains a consideration, though it is generally manageable with proper patient selection and technique. It is fundamentally important to tailor the specific treatment strategy to the clinical and anatomical characteristics of each patient. Percutaneous treatments for acute PE and DVT represent valuable options in the therapeutic arsenal, offering enhanced outcomes in appropriately selected patients. Ongoing advancements in technology and technique, along with comprehensive clinical trials, are essential to further define the role and optimize the use of these interventions.

Daggumati, L., et al. (2025). "The Effect of Thrombolysis of Deep Vein Thrombosis on Late Symptoms of Post–Pulmonary Embolism Syndrome." Journal of Vascular and Interventional Radiology 36(6): 1026-1030 https://www.sciencedirect.com/science/article/pii/S1051044325002167 PDF AT LINK

                In the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial, 691 patients were randomly assigned to receive or not receive pharmacomechanical catheter-directed thrombolysis (PCDT) to treat acute proximal deep vein thrombosis (DVT). Serious adverse events and suspected pulmonary embolism (PE) (collectively, “late symptom events” [LSEs]) were reported. An independent physician, blinded to treatment allocation, categorized LSEs occurring 1–24 months after randomization by whether they could relate to post-PE syndrome. PE-related LSEs were frequent (66.7%) in patients who presented with diagnosed or suspected PE and infrequent (2.0%) in others; however, PCDT did not influence their occurrence (PCDT, 11.0% vs No-PCDT, 11.0; P = 1.000). However, in the iliofemoral DVT subgroup, patients in the PCDT arm had fewer PE-related LSEs per patient (PCDT, 0.14 vs No-PCDT, 0.24; P = .036) and fewer PE-related breathing/lung LSEs per patient (PCDT, 0.08 vs No-PCDT, 0.16; P = .023). PCDT was associated with a lower incidence of PE-related LSEs in patients with iliofemoral DVT who presented with PE symptoms at baseline. Evaluation for post-PE syndrome after DVT thrombolysis can be focused on this subset of patients.

Ismayl, M., et al. (2024). "Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: A systematic review and meta-analysis." Cardiovascular Revascularization Medicine 60: 43-52 https://www.sciencedirect.com/science/article/pii/S1553838923008321 REQUEST ARTICLE

Introduction: Controversy surrounds the optimal therapy for submassive and massive pulmonary embolism (PE). We conducted a systematic review and meta-analysis to compare the outcomes of catheter-directed thrombolysis (CDT) versus surgical and catheter-based thrombectomy in patients with submassive and massive PE. Methods We searched PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing outcomes of CDT versus thrombectomy in submassive and massive PE. Studies were identified and data were extracted by two independent reviewers. A random effects model was used to calculate risk ratios (RRs) with 95 % confidence intervals (CIs). Outcomes included in-hospital mortality, procedural complications, hospital and intensive care unit (ICU) length of stay (LOS), 30-day readmissions, and right ventricle/left ventricle (RV/LV) ratio improvement. Results Eight observational studies with 1403 patients were included, of whom 50.0 % received CDT. Compared to thrombectomy, CDT was associated with significantly lower in-hospital mortality (RR 0.62; 95 % CI 0.43–0.89; p = 0.01) and similar rates of major bleeding (p = 0.61), blood transfusion (p = 0.41), stroke (p = 0.41), and atrial fibrillation (p = 0.71). The hospital and ICU LOS, 30-day readmissions, and degree of RV/LV ratio improvement were similar between the two strategies (all p > 0.1). In subgroup analyses, in-hospital mortality was similar between CDT and catheter-based thrombectomy (p = 0.48) but lower with CDT compared with surgical thrombectomy (p = 0.01). Conclusions In patients with submassive and massive PE, CDT was associated with similar in-hospital mortality compared to catheter-based thrombectomy, but lower in-hospital mortality compared to surgical thrombectomy. Procedural complications, LOS, 30-day readmissions, and RV/LV ratio improvement were similar between CDT and any thrombectomy. Randomized controlled trials are indicated to confirm our findings.

Li, K., et al. (2021). "Treatment of acute pulmonary embolism using rheolytic thrombectomy." EuroIntervention 17(2): e158-e166  https://pmc.ncbi.nlm.nih.gov/articles/PMC9725013/pdf/EIJ-D-20-00259_Li.pdf

PDF AT LINK

                BACKGROUND: The AngioJet rheolytic thrombectomy (ART) system can quickly fragment and aspirate thrombi according to Bernoulli's principle. AIMS: This retrospective study aimed to evaluate the therapeutic effects of the ART system in treating severe acute pulmonary embolism (APE), including high-risk pulmonary embolism (HR-PE) and intermediate-high-risk pulmonary embolism (IHR-PE). METHODS: Forty-four APE patients (21 HR-PE and 23 IHR-PE) were enrolled and underwent pulmonary ART using the 6 Fr Solent Omni AngioJet device. Nineteen patients were diagnosed with APE and lower extremity deep venous thrombosis (LEDVT), and underwent thrombectomy of APE and LEDVT simultaneously using ART. All patients also received local thrombolysis with urokinase. RESULTS: The results showed that the mean length of stay in intensive care units was 2.4±1.9 days. Significant improvements in clinical, haemodynamic and angiographic parameters were observed in both groups; the improvements in shock index, PaO2, and angiographic parameters were more obvious in the IHR-PE group. Six of the 44 patients died in hospital. During the follow-up, 35 of 38 patients were functioning well and no recurrence of APE was observed. CONCLUSIONS: Pulmonary ART plus local thrombolysis of the pulmonary artery for HR-PE or IHR-PE is feasible and appears to be safe. Further studies are warranted to investigate comparative efficacy compared to existing treatments.