Key result
A 5-minute delay in thrombolysis is linked to higher in-hospital mortality in high-risk PE.
Why the study?
Does delaying thrombolytic therapy administration increase 24-hour in-hospital mortality in patients presenting to the emergency department with high-risk acute pulmonary embolism?
Observational (n=49)
No
Does delaying thrombolytic therapy administration increase 24-hour in-hospital mortality in patients presenting to the emergency department with high-risk acute pulmonary embolism?
Early administration of systemic thrombolytic therapy within 1 hour of emergency department admission or within 10 minutes of cardiac arrest is strongly associated with improved survival without major bleeding in patients with high-risk pulmonary embolism.
Answers are grounded in this paper and cite their sources.
Minimizing thrombolytic delays may reduce mortality in high-risk PE; this Level 3 association leaves open causality and requires RCT confirmation.
Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668-0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818-2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving.
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Beydilli et al. (2016) conducted an observational in High-risk acute pulmonary embolism (n=49). Delayed thrombolytic therapy (time to administration of tissue plasminogen activator [rt-PA]) vs. Early thrombolytic administration (e.g., within 1 hour of ED admission or without 5-minute increments of delay) was evaluated on 24-hour / in-hospital mortality in relation to a 5-minute delay in thrombolytic therapy (beta = 0.071 in Table 2 (reported as beta = 1.342 in abstract), 95% CI 0.045-0.096, p=0.001). A 5-minute delay in thrombolytic therapy administration was independently associated with increased in-hospital mortality in patients with high-risk acute pulmonary embolism.
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