Study of Clinical Profile and Management of Patients with Pulmonary Embolism using Catheter Directed Thombolysis ? Single Center Study

Objective To study the clinical profile, diagnostic methods and management by Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysisin patients with symptomatic pulmonary embolism (PE). Methods Retrospective assessment of clinical features and management of patients presenting with symptomatic pulmonary embolism from January 2011 to may 2017. Results 63 patients who were newly diagnosed to have pulmonary embolism with a mean age of 52.1 years were included in the study. Dyspnea (91.4 %) and syncope (22.8 %) were the predominant symptoms. Echocardiography was done in all patients.55 patients (85.7 %) had pulmonary arterial hypertension, 55 patients (88.5 %) had evidence of RV dysfunction and 10 patients (16.7 %) had evidence of thrombus in PA, RV. Out of 63 patients, 61 patients (97.14 %) showed positive d-dimer reports. Among 63 patients, 43 (68.5 %) had positive troponin values. CT pulmonary angiogram (CTPA) was done in 43 patients (68.5 %. ). Systemic thrombolysis was done is 15 patients (34.8 %) and 28 (44.4 %) pt were subjected to CDT. Of the 15 patients, 14 (97.1 %) were discharged and were under regular follow up for 6 months and one patient died during the hospital stay. Clinical success was achieved in 24 of 28 patients with massive PE (85.7 %, 95 % CI, 67.3 %-96.0 %). The mean pulmonary artery pressure improved from 51.17 14.06 to 37.23 15.81 mm Hg (n = 63) (P less than.0001). Among patients monitored with follow-up echocardiography, 57 of 63 (89.1 %, 95 % CI, 78.8 %-95.5 %, P less than.0001) showed improvement in right-sided heart strain. There were no major procedure-related complications, major hemorrhages, or hemorrhagic strokes. Conclusion Pulmonary embolism is a common problem and can be easily diagnosed provided it is clinically suspected. Early diagnosis and aggressive management is the key to successful outcome.