Key result
Thrombolysis plus anticoagulation shows no survival benefit over anticoagulation alone in PE complicated by shock.
Why the study?
The study aimed to compare the efficacy of anticoagulation therapy and thrombolytic therapy for pulmonary embolism complicated with shock.
Does thrombolysis plus anticoagulation improve in-hospital and 90-day mortality compared to anticoagulation alone in patients with pulmonary embolism complicated by shock?
Cohort (n=820)
Yes
Does thrombolysis plus anticoagulation improve in-hospital and 90-day mortality compared to anticoagulation alone in patients with pulmonary embolism complicated by shock?
In a propensity-matched cohort of patients with pulmonary embolism complicated by shock, thrombolysis did not significantly reduce in-hospital or 90-day mortality compared to anticoagulation alone.
Answers are grounded in this paper and cite their sources.
Thrombolysis should not yet change practice in PE with shock; leaves open benefit in randomized trials.
OBJECTIVE: This study aimed to compare the efficacy of anticoagulation therapy and thrombolytic therapy for pulmonary embolism (PE) in patients complicated with shock. METHODS: This retrospective cohort study used administrative data from Taiwan's National Health Insurance Research Database. Patients admitted due to PE who received inotropic support between January 1, 1997, and December 31, 2011, were included. To closely mimic a randomized experiment, anticoagulation and thrombolysis plus anticoagulation groups were subjected to propensity score matching (PSM) according to demographic characteristics, comorbidities, and inotropic agent dosage. The primary outcome was in-hospital mortality. The secondary outcome was 3-month mortality after discharge. RESULTS: After PSM, a total of 820 patients, including 164 thrombolysis and 656 anticoagulation patients, were enrolled. The in-hospital mortality was 48.2% in the thrombolysis group and 52.4% in the anticoagulation group (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.59-1.18). Major bleeding occurred in 19 (11.6%) of the thrombolysis patients and 57 (8.7%) of the anticoagulation patients (OR 1.37, 95% CI, 0.79-2.38). The 90-day mortality rates in the thrombolysis and anticoagulation groups were 15.3% (13 patients) and 17.6% (55 patients), respectively; this difference was not significant (hazard ratio 0.88, 95% CI 0.48-1.61). CONCLUSION: In PE patients complicated with shock, anticoagulation therapy provides similar treatment efficacy to thrombolytic therapy in terms of in-hospital and 90-day mortality. The bleeding risk was also similar in the two treatment groups.
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Lee et al. (2020) conducted a cohort in Pulmonary embolism complicated with shock (n=820). Thrombolysis plus anticoagulation vs. Anticoagulation alone was evaluated on In-hospital mortality (OR 0.84, 95% CI 0.59-1.18). Thrombolysis plus anticoagulation provided similar in-hospital mortality compared to anticoagulation alone in patients with pulmonary embolism complicated by shock (48.2% vs 52.4%; OR 0.84, 95% CI 0.59-1.18).
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