Intermediate High Risk (Ihr) Pe: The Value Of A Pe Lysis Team (Pelt)

Introduction: IHR PE management is challenging; thrombolysis reduces risk of haemodynamic collapse but increases bleeding risk1. We have shown safe use of half-dose systemic and catheter directed thrombolysis (CDT) in a cohort of 57 patients from 2014-2016. Aim: To review outcomes of IHR and high-risk (HR) PE from 2018-2019 and compare with our historical cohort. Methods: A retrospective review of PE cases admitted from 2018-2019. 126 patients were identified via thrombosis database and case notes were reviewed. PELT review (includes PESI, troponin/BNP, imaging and clinical/bleeding risk assessment) facilitates risk stratification and treatment selection. Standard care is unfractionated heparin infusion (UFH) & review at 24 hours unless the patient is very unwell. Any decision to thrombolyse is made by PELT in conjunction with informed patient consent. Results: 74 (59%) were formally referred to PELT (109 IHR, 17 HR). Table 1 shows the outcomes. 95% of CDT patients had a high bleeding risk. Thrombolysis had only 4 minor and no major bleeding complications. No mortality is related to treatment but to underlying disease or multiorgan failure. Conclusions: PELT referrals have increased. Conservative management with UFH in selected patients is effective in the majority of cases. Thrombolysis gives good outcomes in carefully chosen patients reviewed by PELT who are very unwell on admission or have failed to respond to standard care. Reference: 1) Meyer, G. et al. NEJM 2014;370:1402-11