The effects of thrombolytic therapy on prognostic clinical markers in patients with intermediate-high risk pulmonary embolism
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Key result
Thrombolytic therapy significantly reduced the 7-day early mortality rate to 5.13% compared to 20.93% with unfractionated heparin alone in patients with intermediate-high risk pulmonary embolism.
Why the study?
To assess the effect of thrombolytic therapy compared to classic therapy on clinical prognostic markers and evaluate associated bleeding risk in intermediate-high risk pulmonary embolism.
Does thrombolytic therapy reduce early mortality and hemodynamic instability in patients with intermediate-high risk pulmonary embolism?
Population
82 consecutive patients with intermediate-high risk pulmonary embolism
Comparison
Thrombolytic therapy vs unfractionated heparin alone
Design
Cohort study
Follow-up
7th day
Authors
Discussion
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Implication
Should not change practice in intermediate-high risk PE due to confounding by bleeding risk; leaves open need for randomized confirmation.
Study Design
Type
Cohort (n=82)
Multicenter
No
Structured PICO
Does thrombolytic therapy reduce early mortality and hemodynamic instability in patients with intermediate-high risk pulmonary embolism?
P
Population
82 consecutive patients aged 18-85 years with intermediate-high risk acute pulmonary embolism, followed for 7 days to assess early mortality and hemodynamic instability.
I
Intervention
Thrombolytic therapy (t-PA 100 mg in 2 hours) combined with anticoagulant therapy (unfractionated heparin dosed depending on aPTT)
C
Comparator
Unfractionated heparin alone dosed according to aPTT (control group included patients with contraindications for thrombolytic therapy or high bleeding risk)
O
Outcome
Early (7th day) mortality rate and hemodynamic instability ratehard clinical
Main Result
Absolute Event Rate: 5.13% vs 20.93%
p-value: p=0.04
In a cohort of patients with intermediate-high risk pulmonary embolism, thrombolytic therapy was associated with reduced early mortality and hemodynamic instability compared to anticoagulation alone, though treatment assignment was confounded by baseline bleeding risk.
Limitations
- Exclusive use of transthoracic echocardiography to assess RV dysfunction
- Short follow-up period of only 7 days
- Small sample size
- Single center study
- Non-randomized design with older, higher bleeding-risk patients assigned to the control group
- Short follow-up period of only 7 days in the acute phase
- Small number of patients
Cite This Study
Ion et al. (2020) conducted a cohort in Intermediate-high risk pulmonary embolism (n=82). Thrombolytic therapy (alteplase/t-PA) vs. Unfractionated heparin alone was evaluated on Early mortality rate at 7 days (p=0.04). Thrombolytic therapy significantly reduced the 7-day early mortality rate to 5.13% compared to 20.93% with unfractionated heparin alone in patients with intermediate-high risk pulmonary embolism.
Topics
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