Primary thrombolytic treatment in hemodynamically stable patients with major pulmonary embolism was associated with lower 30-day mortality (4.7% vs 11.1%, P=0.016) compared to heparin alone.
Observational (n=719)
Yes
Does primary thrombolytic treatment reduce 30-day mortality in hemodynamically stable patients with major pulmonary embolism compared to heparin alone?
In hemodynamically stable patients with major pulmonary embolism, primary thrombolysis may reduce mortality and recurrent PE, but at the cost of increased major bleeding.
Effect estimate: OR 0.46 (95% CI 0.21 to 1.00)
Absolute Event Rate: 4.7% vs 11.1%
p-value: p=0.016
BACKGROUND: Thrombolytic treatment has been shown to accelerate resolution of major pulmonary embolism and lead to a rapid improvement of right-side hemodynamics. However, the association between these favorable effects and the clinical outcome of patients who have no severe hemodynamic compromise at presentation remains unknown. METHODS AND RESULTS: The present multicenter registry included 719 consecutive patients with major pulmonary embolism according to clinical, echocardiographic, scintigraphic, and cardiac catheterization criteria. Symptom onset was acute (<48 hours) in 63% of patients. All patients were hemodynamically stable (ie, without evidence of cardiogenic shock) at presentation. Primary thrombolytic treatment (within 24 hours of diagnosis) was given to 169 patients (23.5%), whereas the remaining 550 patients were initially treated with heparin alone. Overall 30-day mortality was significantly lower in the patients who received thrombolytic agents (4.7 versus 11.1%, P=.016). Clinical factors associated with a higher death rate were syncope (P=.012), arterial hypotension (P=.021), history of congestive heart failure (P=.013), and chronic pulmonary disease (P=.032). However, only primary thrombolysis was found by multivariate analysis to be an independent predictor of survival (odds ratio for in-hospital death, 0.46; 95% confidence interval, 0.21 to 1.00). Patients who underwent early thrombolytic treatment had a reduced rate of recurrent pulmonary embolism (7.7 versus 18.7%, P<.001) but also a higher frequency of major bleeding episodes (21.9% versus 7.8%, P<.001). Cerebral bleeding occurred in 2 patients in each treatment group, and 1 patient in each group died of a bleeding complication. CONCLUSIONS: The results of our study suggest that thrombolysis may favorably affect the clinical outcome of hemodynamically stable patients with major pulmonary embolism.
Konstantinides et al. (Tue,) conducted a observational in Major pulmonary embolism (n=719). Primary thrombolytic treatment vs. Heparin alone was evaluated on Overall 30-day mortality (OR 0.46, 95% CI 0.21 to 1.00, p=0.016). Primary thrombolytic treatment in hemodynamically stable patients with major pulmonary embolism was associated with lower 30-day mortality (4.7% vs 11.1%, P=0.016) compared to heparin alone.