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Evaluation of real-world use of pulmonary embolism thrombolysis: Erupt

Lookup NU author(s): Dr Joe Kibbler, Professor Anthony De SoyzaORCiD

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Abstract

© The authors 2025.Introduction International guidelines recommend systemic thrombolysis for high-risk acute pulmonary embolism (PE). Significant uncertainties remain regarding thrombolysis in non-high-risk PE and the use of reduced-dose thrombolysis. To address this, UK respiratory trainees led a multicentre UK-wide study assessing current practice. Our primary aim was to evaluate UK practice against the European Society of Cardiology recommendations (specifically to utilise full-dose thrombolysis only in high-risk PE). Secondary outcomes included mortality and an analysis of clinical factors associated with administrating reduced-dose thrombolysis. Method This was a retrospective multicentre observational study evaluating thrombolysis of acute PE from September 2021 to September 2022 in 26 centres across the UK. Results A total of 174 patients from 26 sites were included, with fibrinolytic dose recorded in 168 (96.6%) cases. After exclusion of 30 cases involving cardiac arrest, 26 out of 138 patients (18.8%) received reduced-dose thrombolysis. 67 (39.9%) patients underwent thrombolysis for non-high-risk PE. Factors associated with receiving reduced-dose thrombolysis included higher age (p=0.005), higher Charlson comorbidity index (p=0.008) and higher serum lactate (p=0.02). Conclusion PE thrombolysis in the UK deviates from international guidelines in a significant minority of cases; comprising the use of reduced-dose regimens and thrombolysis in non-high-risk cases without haemodynamic deterioration. Prospective real-world studies, assessing clinical practice and outcomes following thrombolysis, should be conducted to understand the pragmatic application of evidence and inform future guidelines.

Publication metadata

Author(s): Sobala R, Kibbler J, Yip K, Thompson R, Rafique C, Steward M, Samanta R, Jha A, Rahman N, De Soyza A

Publication type: Article

Publication status: Published

Journal: ERJ Open Research

Year: 2025

Volume: 11

Issue: 3

Print publication date: 01/05/2025

Acceptance date: 13/12/2024

Date deposited: 04/08/2025

ISSN (electronic): 2312-0541

Publisher: European Respiratory Society

URL: https://doi.org/10.1183/23120541.00935-2024

DOI: 10.1183/23120541.00935-2024

Data Access Statement: All data are included in the article.

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