Comparison of Treatment Approaches and Subsequent Outcomes within a Pulmonary Embolism Response Team Registry
Research article published in Critical care research and practice (2024)
Abstract
OBJECTIVES: To characterize the association between pulmonary embolism (PE) severity and bleeding risk with treatment approaches, outcomes, and complications. METHODS: Secondary analysis of an 11-hospital registry of adult ED patients treated by a PE response team (August 2016-November 2022). Predictors were PE severity and bleeding risk. The primary outcome was treatment approach: anticoagulation monotherapy vs. advanced intervention (categorized as "immediate" or "delayed" based on whether the intervention was received within 12 hours of PE diagnosis or not). Secondary outcomes were death, clinical deterioration, and major bleeding. RESULTS: Of the 1832 patients, 139 (7.6%), 977 (53.3%), and 9 (0.5%) were classified as high-risk, intermediate-high, intermediate-low, and low-risk severity, respectively. There were 94 deaths (5.1%) and 218 patients (11.9%) had one or more clinical deterioration events. Advanced interventions were administered to 86 (61.9%), 195 (27.6%), and 109 (11.2%) patients with high-risk, intermediate-high, and intermediate-low severity, respectively.Major bleeding occurred in 61/1440 (4.2%) on ACm versus 169/392 (7.6%) with advanced interventions (p <0.001): bleeding withcatheter-directed thrombolysiswas 19/145 (13.1%) versus 33/154(21.4%) with systemic thrombolysis,p= 0.07. High risk was twice as strong as intermediate-high risk for association with advanced intervention (OR: 5.3 (4.2 and 6.9) vs. 1.9 (1.6 and 2.2)). High risk (OR: 56.3 (32.0 and 99.2) and intermediate-high risk (OR: 2.6 (1.7 and 4.0)) were strong predictors of clinical deterioration. Major bleeding was significantly associated with advanced interventions (OR: 5.2 (3.5 and 7.8) for immediate, 3.3 (1.8 and 6.2)) for delayed, and high-risk PE severity (OR: 3.4 (1.9 and 5.8)). CONCLUSIONS: Advanced intervention use was associated with high-acuity patients experiencing death, clinical deterioration, and major bleeding with a trend towards less bleeding with catheter-directed interventions versus systemic thrombolysis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This secondary analysis of an 11-hospital pulmonary embolism response team registry (1832 patients) examined how PE severity and bleeding risk related to treatment choice and outcomes, finding advanced interventions concentrated in higher-acuity patients, higher major-bleeding rates with advanced interventions than with anticoagulation monotherapy (7.6% vs 4.2%), and a non-significant trend toward less bleeding with catheter-directed than systemic thrombolysis. For hirudotherapy the connection is contextual rather than direct: it illustrates the central clinical trade-off between preventing thrombosis and provoking bleeding that underlies all anticoagulant decision-making, the same balance that frames interest in leech-derived direct thrombin inhibitors, though this registry studied heparin-based anticoagulation and thrombolysis, not leech therapy. As an observational multicenter registry analysis, its findings show associations and practice patterns, not causal effects, and bleeding differences between thrombolysis routes did not reach significance.
Citation
Comparison of Treatment Approaches and Subsequent Outcomes within a Pulmonary Embolism Response Team Registry.
Weekes et al. · Critical care research and practice, 2024
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