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

IntroductionInternational 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.MethodThis was a retrospective multicentre observational study evaluating thrombolysis of acute PE from September 2021 to September 2022 in 26 centres across the UK.ResultsA 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).ConclusionPE 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.