Key result
In patients with suspected pulmonary embolism receiving thrombolytic therapy, the estimated risk of major bleeding was 14.0% following pulmonary angiography versus 4.2% following noninvasive diagnosis.
Why the study?
Does noninvasive diagnosis compared to invasive diagnosis reduce the risk of major bleeding in patients with suspected pulmonary embolism receiving thrombolytic therapy?
Does noninvasive diagnosis compared to invasive diagnosis reduce the risk of major bleeding in patients with suspected pulmonary embolism receiving thrombolytic therapy?
Noninvasive diagnostic testing prior to thrombolytic therapy in patients with suspected pulmonary embolism is estimated to result in fewer major bleeding complications compared to invasive pulmonary angiography.
Answers are grounded in this paper and cite their sources.
Noninvasive diagnosis may reduce major bleeding with thrombolysis in suspected PE; leaves open need for prospective validation before practice change.
OBJECTIVE: To assess the relative risks for bleeding with thrombolytic therapy in patients who are managed using pulmonary angiograms compared with those managed using noninvasive tests, primarily the ventilation-perfusion lung scan. DESIGN: A decision analysis based on data from other studies. METHODS: The risk for major bleeding in patients with pulmonary embolism who receive thrombolytic therapy after a noninvasive diagnosis was assessed from complications of thrombolytic therapy in patients with myocardial infarction, assuming that the same risk ratio for major bleeding when comparing an invasive with a noninvasive approach applied to patients with pulmonary embolism. The risk ratio was 3.3 (95% CI, 1.5 to 9.8) for major bleeding in patients with myocardial infarction. One or more major complications of pulmonary angiography occurred in 1.3% of patients (CI, 0.6% to 1.9%). RESULTS: The average reported risk was 14% (18 of 129 patients) (CI, 7.9% to 20.1%) for major bleeding in patients who had pulmonary angiography before receiving tissue plasminogen activator (tPA). The estimated risk was 4.2% (estimated CI, 1.4% to 9.3%) for major bleeding with tPA after a noninvasive diagnosis of pulmonary embolism. Assuming a risk of 1.3% for major complications from pulmonary angiography, a risk for major hemorrhage of 14.0% for an invasive diagnosis, and a risk of 4.2% for a noninvasive diagnosis, fewer complications would occur with noninvasive management if the prevalence of pulmonary embolism exceeded 21%. CONCLUSION: Among patients with suspected pulmonary embolism who are candidates for thrombolytic therapy, it is safer to use noninvasive diagnostic tests in many patients.
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Stein et al. (1994) studied Acute Pulmonary Embolism. Pulmonary angiography (invasive management) vs. Noninvasive tests (ventilation-perfusion lung scan) was evaluated on Major bleeding. In patients with suspected pulmonary embolism receiving thrombolytic therapy, the estimated risk of major bleeding was 14.0% following pulmonary angiography versus 4.2% following noninvasive diagnosis.
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