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22 March 2017

Doctors are failing to give high-risk pulmonary embolism patients the most effective treatments, US-based research has claimed.

Usual treatments include anticoagulants, but for the 30% in the higher-risk category they can also have catheter-directed thrombolysis (CDT) and systemic thrombolysis (ST), both of which use tissue plasminogen activator (tPA), according to the researchers.

However, in the first research of its kind, researchers from the Perelman School of Medicine at the University of Pennsylvania have found that the use of these potentially life-saving medications is low, particularly among patients who are critically ill.

Dr Srinath Adusumalli, chief cardiovascular medicine fellow in the Perelman School of Medicine at the University of Pennsylvania, and colleagues undertook a retrospective study, collecting data from the OptumInsight national commercial insurance claims database.

They identified 100,744 patients who had been hospitalised with PE between 2004 and 2014. Of these, 2,175 (about 2%) patients received either CDT or ST. Over the same 10-year period, the number of PE hospitalisations increased by 306%.

Dr Adusumalli said: 'Our initial data suggest that, in fact, both ST and CDT are used infrequently to treat pulmonary embolism, including in young, critically ill patients who may experience the highest clinical benefit from those therapies.'

The findings were presented at the American College of Cardiology 66th Annual Scientific Session in Washington.

A larger team at Penn Medicine, including those who were involved with this study, created the Pulmonary Embolism Response Team (PERT), which is designed to employ rapid response techniques for the treatment of PE to match the right patient to the right therapy at the right time.

Dr Jay Giri, an assistant professor of Cardiovascular Medicine and founder of the PERT at the Hospital of the University of Pennsylvania, said: 'It is important to state that most decisions made by PERT physicians are a matter of clinical consensus rather than being based on rigorous comparative effectiveness research. The current study re-emphasises the clinical consequences of the dearth of data in the PE field.'


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