Introduction PE is common and life-threatening. Thrombolysis with 100 mg alteplase is recommended in cardiac arrest and haemodynamic instability,¹ however best management for intermediate-risk PE is unclear. The PEITHO study demonstrated excess bleeding risk with thrombolysis in this setting; a randomised trial of reduced-dose thrombolysis will complete in 4 years.²

Trainees identified variability in thrombolysis use and uncertainty about best practice, prompting the selection of ERUPT, the first project delivered by the INSPIRE trainee respiratory research national network. This multicentre, retrospective observational study of patients treated with thrombolysis for PE aimed to describe current UK practice and patient outcomes.

Method Patients aged ≥18, treated with alteplase for acute PE during 1 year from 1st September 2021 were identified via pharmacy records. Patient and PE characteristics, treatment and outcomes were extracted.PE and thrombolysis incidence were estimated from local coding searches. The primary focus was complication rates; frequency of thrombolysis in non-high-risk PE and frequency of half-dose thrombolysis was also captured.

Results 25 sites in England and Northern Ireland contributed 170 cases. Comorbidity rates were generally low, although 10% had active malignancy. Coding searches suggested thrombolysis was used in 1.5% of PE cases, and 24.1% of cases with right heart dysfunction.

59% of thrombolysis occurred in high-risk PE, 39% occurred in intermediate-risk and 1% in low-risk. A reduced alteplase dose was used in 40% of high-risk and 12% of intermediate-risk cases.

Table 1A displays complication rates. Complications were recorded in 52.5% of high-risk and 23.9% of intermediate-risk cases. High-risk cases treated with reduced-dose thrombolysis had significant complications in 62.2% of cases (vs 46.0% treated with full-dose, p=0.148; Fisher’s exact test).

Strikingly, almost half of PE thrombolysis involved practice outwith recommendations, although outcomes were not significantly worse. To complement future randomised trials, a registry of hospitalised PE cases would provide data to help clinicians navigate the thrombolysis decisions with their patients.

References

1. Konstantinides, S, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. European heart journal, 2020;41(4), 543–603.

2. National Institutes of Health. Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3). Clinicaltrials.gov; 2020. https://clinicaltrials.gov/ct2/show/NCT04430569

ReferencesPlease refer to page A283 for declarations of interest related to this abstract.