The use of thrombolytic therapy in a multidisciplinary pulmonary embolism response team

Introduction: The implementation of a pulmonary embolism response team (PERT) is associated with an increase in the use of thrombolysis, in particular, catheter-directed thrombolysis (CDT). Expert multidisciplinary PERTs may use thrombolysis outside of guideline recommendations, but the clinical characteristics of patients treated with thrombolysis by PERT clinicians are not well described. Materials and methods: This study was based on all confirmed pulmonary embolism (PE) patients within the MGH PERT database as of January 1st, 2019. Patients were stratified according to treatment strategy and divided into patients having received any thrombolytic treatment (AT), CDT, intravenous thrombolysis (IVT) or no clot reducing therapy (NCR). Data were extracted on demographics, symptoms, medical history, clot burden, right heart strain, biochemistry and operational characteristics. Furthermore, patients were risk-stratified according to ESC guidelines. Univariate analyzes were performed for three different comparisons; AT vs NCR, CDT vs NCR and CDT vs IVT. Results: Among confirmed PE patients, 109/831 (13.1%) underwent thrombolytic therapy. Thrombolysis was divided between 74 (8.9%) CDT and 35 (4.2%) IVT. Central clot burden (p ​