Thrombolytic therapy was administered to 48% of patients with acute major pulmonary embolism, with initial thrombolysis being significantly more frequent in clinically unstable patients (57% vs 22%).
Observational (n=1,001)
Yes
What are the current management strategies and determinants of in-hospital outcomes in patients with acute major pulmonary embolism?
In acute major pulmonary embolism, management strategies rely heavily on hemodynamic stability, with unstable patients frequently receiving thrombolysis based on bedside echocardiography and experiencing high in-hospital mortality.
OBJECTIVES: The present study investigated current management strategies as well as the clinical course of acute major pulmonary embolism. BACKGROUND: The clinical outcome of patients with acute pulmonary embolism who present with overt or impending right heart failure has not yet been adequately elucidated. METHODS: The 204 participating centers enrolled a total of 1,001 consecutive patients. The inclusion criteria were based on the clinical findings at presentation and the results of electrocardiographic, echocardiographic, nuclear imaging and cardiac catheterization studies. RESULTS: Echocardiography was the most frequently performed diagnostic procedure (74%). Lung scan or pulmonary angiography were performed in 79% of clinically stable patients but much less frequently in those with circulatory collapse at presentation (32%, p < 0.001). Thrombolytic agents were given to 478 patients (48%), often despite the presence of contraindications (193 40% of 478). The frequency of initial thrombolysis was significantly higher in clinically unstable than in normotensive patients (57% vs. 22%, p < 0.001). Overall in-hospital mortality rate ranged from 8.1% in the group of stable patients to 25% in those presenting with cardiogenic shock and to 65% in patients necessitating cardiopulmonary resuscitation. Major bleeding was reported in 92 patients (9.2%), but cerebral bleeding was uncommon (0.5%). Finally, recurrent pulmonary embolism occurred in 172 patients (17%). CONCLUSIONS: Current management strategies of acute major pulmonary embolism are largely dependent on the degree of hemodynamic instability at presentation. In the presence of severe hemodynamic compromise, physicians often rely on the findings of bedside echocardiography and proceed to thrombolytic treatment without seeking further diagnostic certainty in nuclear imaging or angiographic studies.
Kasper et al. (Sat,) conducted a observational in Acute major pulmonary embolism (n=1,001). Thrombolytic agents was evaluated on In-hospital mortality. Thrombolytic therapy was administered to 48% of patients with acute major pulmonary embolism, with initial thrombolysis being significantly more frequent in clinically unstable patients (57% vs 22%).