New research by Carle Illinois College of Medicine students could play a pivotal role in developing clear guidelines for treating blood clots that become lodged in the arteries of the lungs. Pulmonary embolism is one of the most common life-threatening cardiovascular conditions. The new study looks at the long-term outcomes of a minimally invasive treatment for PE called catheter-directed thrombolysis, which restores blood flow by delivering special clot-dissolving medications directly to the affected pulmonary artery. The team’s findings are the first to provide insight into the long-term outcomes of the procedure and risk factors for clot recurrence that could lead to better treatment decisions and guidelines.
CI MED students, faculty, and Carle Health researchers studied a decade of patient data that revealed the five-year survival rates of patients undergoing catheter-directed thrombolysis (CDT) to treat pulmonary clots. “CDT is particularly prominent in treating patients with intermediate-risk PE,” CI MED student and study co-author Tessabella Magliochetti Cammarata explained. “It offers a targeted approach to removing the clot, which potentially improves outcomes and reduces the risk of long-term complications,” she said.
In the CDT procedure, doctors insert a catheter into a vein in the groin or arm and thread it through to the pulmonary arteries where the blood clot is located. The catheter delivers clot-dissolving medication, such as tissue plasminogen activator (tPA), directly to the clot to break down the blockage and restore blood flow to the lung tissue. The treatment reduces symptoms, improves oxygenation, and prevents other complications associated with PE.
However, for most patients with PE, CDT treatment is only part of the solution to a problem that is prone to recur. Clots that lodge in the arteries in the lungs often originate in other parts of the body, such as in the leg, and travel up the bloodstream. It’s common for post-PE treatment to include blood thinners (anticoagulants) to prevent clots from developing in the future, so the CI MED team also studied how patients responded to post-CDT therapy.
Key long-term findings of the study include:
- Five-year mortality following CDT was significant at 18.7%
- 9.2% of deaths at five years were attributed to cardiopulmonary causes
- Five-year mortality was highest (78.5 %) in patients without anticoagulation therapy following CDT
- Five-year mortality was lowest (10.9 %) in patients on apixaban (Eliquis)
- Risk factors associated with mortality include advanced age, female sex, and lack of anticoagulation therapy
Magliochetti Cammarata says the team’s findings underscore the importance of personalized treatment strategies, ongoing monitoring, and the need for further research to optimize outcomes for patients with PE undergoing CDT.
“The findings of this study can contribute to the development of guidelines for the management of intermediate-risk PE, an area that currently lacks clear consensus,” Magliochetti Cammarata said. She notes that this work also paves the way for randomized control trials comparing different blood-thinning therapies. “Insights into the effectiveness of different anticoagulants post-CDT can lead to updates in treatment guidelines, potentially improving patient outcomes and reducing complications,” she said.
In addition to Magliochetti Cammarata, the research team includes CI MED students Daniel Cheah and Nellie Haug; CI MED Clinical Associate Professor Vishesh Paul and Associate Professor Danish Thameem; and Carle Health Internal Medicine Resident Sushan Gupta, MD, and Cardiology Fellow Talha Bin Farooq, MD.
The paper, “Long-term outcomes and predictors of mortality in patients with pulmonary embolism undergoing catheter-directed thrombolysis: a 10-year retrospective study,” was published in the journal Current Problems in Cardiology.