In Patients with Submassive Pulmonary Embolism, does Catheter Direct Thrombolysis Reduce Mortality Compared to Anticoagulation

Introduction: PE is a life-threatening condition leading to obstructed blood flow and compromised gas exchange. Prompt recognition and treatment are crucial to improving outcomes and reducing mortality, particularly in patients with submassive PE. This paper evaluates the effectiveness of catheter-directed thrombolysis (CDT) in enhancing treatment protocols for PE compared to standard anticoagulation. Methods: A literature review was conducted using the PubMed database, focusing on articles related to pulmonary embolism, anticoagulation, and catheter thrombolysis from 2019 to 2024. The search, refined by MeSH terms and Boolean operators, yielded 192 results, narrowed down to 16 relevant randomized control trials, meta-analyses, and systematic reviews. Studies were selected based on specific criteria, such as using PRISMA guidelines, the Newcastle-Ottawa scale, and Cochrane bias risk assessment. Results: Ultimately four articles were reviewed three of which were meta-analyses that used PRISMA, Cochrane methodology, and the Newcastle-Ottawa scale, and one ongoing randomized control trial. These studies showed that CDT may decrease in-hospital mortality associated with submassive PE. Discussion: The studies included in the paper consistently found that CDT was associated with a lower risk of death than systemic thrombolysis in patients with submassive PE. While CDT may show a significant reduction in in-hospital and short-term mortality compared to anticoagulation alone, the studies also highlighted gaps in evidence, particularly in establishing CDT as a first-line treatment. Ongoing trials are expected to provide more conclusive data on the long-term efficacy and safety of CDT.