Catheter-directed thrombolysis may offer a safer alternative for high-risk patients with pulmonary embolism

Reviewed by Megan Craig, M.Sc.Jul 31 2023

Pulmonary embolism (PE), a life-threatening condition caused by blood clots in the lung, has long posed a significant risk to patients worldwide. However, a recent study published in the Canadian Medical Association Journal (CMAJ) suggests that catheter-directed thrombolysis (CDT) may offer a safer alternative for high-risk PE patients. The research indicates a lower risk of death and bleeding complications associated with CDT compared to other treatments.

Pulmonary embolism (PE) is currently the third leading cause of death from heart disease after myocardial infarction (heart attacks) and stroke. Early diagnosis is essential as a staggering one in three deaths occur within the first few hours compared with only 7% of deaths in properly diagnosed and treated cases.

Catheter-directed thrombolysis (CDT) is a procedure that involves delivering low doses of medication directly into the pulmonary arteries using a catheter. However, due to the lack of comprehensive research on its safety and efficacy, treatment guidelines for CDT vary because of this uncertainty.

In a comparative analysis of different treatments for pulmonary embolisms, Israeli researchers have made a significant breakthrough. The study found that CDT was associated with a 55% decreased risk of death as well as lower risks of major bleeding and brain bleeds among 65%, when compared to other treatment options.

Dr. Bruria Hirsh Raccah, Clinical pharmacist in the cardiology department at the Hadassah Medical Center and researcher at the Hebrew University of Jerusalem and a co-author of the study, cautions that "further research is necessary before drawing definitive conclusions. However, the findings indicate that CDT should be considered the preferred treatment among eligible patients, given its safety and effectiveness, especially when compared to the higher toxicity of systemic thrombolysis."

"Although this study should be interpreted as hypothesis generating, our findings suggest that, among patients eligible for CDT and where facilities exist, CDT should be the preferred treatment, given its safety and effectiveness, and given the higher toxicity of systemic thrombolysis" writes Dr. Bruria Hirsh Raccah, a researcher at the Hebrew University of Jerusalem, Jerusalem, Israel, with coauthors.

The study was part of Stav Yanko's dissertation at the Hebrew University of Jerusalem.

The study was co-authored by Bruria Hirsch Raccah, Stav Yanko and other researchers from Hadassah Medical Center.