PMID- 36740697 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230208 IS - 2052-0492 (Print) IS - 2052-0492 (Electronic) IS - 2052-0492 (Linking) VI - 11 IP - 1 DP - 2023 Feb 6 TI - Effectiveness of systemic thrombolysis on clinical outcomes in high-risk pulmonary embolism patients with venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study. PG - 4 LID - 10.1186/s40560-023-00651-w [doi] LID - 4 AB - BACKGROUND: Current guidelines recommend systemic thrombolysis as the first-line reperfusion treatment for patients with high-risk pulmonary embolism (PE) who present with cardiogenic shock but do not require venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, little is known about the optimal reperfusion treatment in high-risk PE patients requiring VA-ECMO. We aimed to evaluate whether systemic thrombolysis improved high-risk PE patients' outcomes who received VA-ECMO. METHODS: This was a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2021. We identified patients who were diagnosed with PE and received VA-ECMO on the day of admission. Patients who received systemic thrombolysis with monteplase or urokinase within two days of initiating VA-ECMO were defined as the thrombolysis group and the remaining patients as the control group. The primary outcome was in-hospital mortality and secondary outcomes were favorable neurological outcomes, length of hospital stay, VA-ECMO duration, total hospitalization cost, major bleeding, and blood transfusion volume. Propensity-score inverse probability of treatment weighting (IPTW) was performed to compare the outcomes between the groups. RESULTS: Of 1220 eligible patients, 432 (35%) received systemic thrombolysis within two days of initiating VA-ECMO. Among the unweighted cohort, patients in the thrombolysis group were less likely to have poor consciousness at admission, out-of-hospital cardiac arrest, and left heart catheterization. After IPTW, the patient characteristics were well-balanced between the two groups The crude in-hospital mortality was 52% in the thrombolysis group and 61% in the control group. After IPTW, in-hospital mortality did not differ significantly between the two groups (risk difference: - 3.0%, 95% confidence interval: - 9.6% to 3.5%). There were also no significant differences in the secondary outcomes. Sensitivity analyses showed a significant difference in major bleeding between the monteplase and control groups (risk difference: 6.9%, 95% confidence interval: 1.7% to 12.1%), excluding patients who received urokinase. There were no significant differences in the other sensitivity and subgroup analyses except for the total hospitalization cost. CONCLUSIONS: Systemic thrombolysis was not associated with reduced in-hospital mortality or increased major bleeding in the high-risk PE patients receiving VA-ECMO. However, systemic thrombolysis with monteplase was associated with increased major bleeding. CI - (c) 2023. The Author(s). FAU - Nishimoto, Yuji AU - Nishimoto Y AD - Division of Cardiology, Osaka General Medical Center, Osaka, Japan. FAU - Ohbe, Hiroyuki AU - Ohbe H AUID- ORCID: 0000-0001-8544-2569 AD - Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan. hohbey@gmail.com. FAU - Matsui, Hiroki AU - Matsui H AD - Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan. FAU - Nakajima, Mikio AU - Nakajima M AD - Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan. AD - Emergency Life-Saving Technique Academy of Tokyo, Foundation for Ambulance Service Development, Tokyo, Japan. FAU - Sasabuchi, Yusuke AU - Sasabuchi Y AD - Data Science Center, Jichi Medical University, Tochigi, Japan. FAU - Sato, Yukihito AU - Sato Y AD - Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. FAU - Watanabe, Tetsuya AU - Watanabe T AD - Division of Cardiology, Osaka General Medical Center, Osaka, Japan. FAU - Yamada, Takahisa AU - Yamada T AD - Division of Cardiology, Osaka General Medical Center, Osaka, Japan. FAU - Fukunami, Masatake AU - Fukunami M AD - Division of Cardiology, Osaka General Medical Center, Osaka, Japan. FAU - Yasunaga, Hideo AU - Yasunaga H AD - Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan. LA - eng GR - 19AA2007/Ministry of Health, Labour and Welfare/ GR - H30-Policy-Designated-004/Ministry of Health, Labour and Welfare/ GR - 17H04141/Ministry of Education, Culture, Sports, Science and Technology/ PT - Journal Article DEP - 20230206 PL - England TA - J Intensive Care JT - Journal of intensive care JID - 101627304 PMC - PMC9901114 OTO - NOTNLM OT - Extracorporeal membrane oxygenation OT - Mortality OT - Propensity score OT - Pulmonary embolism OT - Thrombolytic therapy COIS- The authors declare that they have no competing interests. EDAT- 2023/02/06 06:00 MHDA- 2023/02/06 06:01 PMCR- 2023/02/06 CRDT- 2023/02/05 23:41 PHST- 2022/11/15 00:00 [received] PHST- 2023/01/24 00:00 [accepted] PHST- 2023/02/05 23:41 [entrez] PHST- 2023/02/06 06:00 [pubmed] PHST- 2023/02/06 06:01 [medline] PHST- 2023/02/06 00:00 [pmc-release] AID - 10.1186/s40560-023-00651-w [pii] AID - 651 [pii] AID - 10.1186/s40560-023-00651-w [doi] PST - epublish SO - J Intensive Care. 2023 Feb 6;11(1):4. doi: 10.1186/s40560-023-00651-w.