Key result
Thrombolytic therapy shows similar clinical efficacy and fatality to anticoagulation in acute submassive PE.
Why the study?
The comparative efficacy and safety of thrombolytic versus anticoagulant therapy for acute submassive pulmonary embolism were unclear.
Does thrombolytic therapy improve clinical outcomes and safety compared to anticoagulant therapy in inpatients with acute submassive pulmonary embolism?
Cohort (n=50)
No
Does thrombolytic therapy improve clinical outcomes and safety compared to anticoagulant therapy in inpatients with acute submassive pulmonary embolism?
In acute submassive pulmonary embolism, thrombolytic therapy provides more rapid physiological and symptomatic relief at 24 hours compared to anticoagulation, but increases bleeding risk without improving overall survival.
Thrombolysis showed no advantage over anticoagulation in this small retrospective series; leaves open optimal therapy for submassive PE pending randomized trials.
This study aimed to compare the efficacy and safety of thrombolytic and anticoagulant therapy for acute submassive pulmonary embolism (PE). A retrospective evaluation was performed on 25 consecutive inpatients with acute submassive PE treated by thrombolytic therapy and 25 earlier consecutive inpatients with acute submassive PE treated by anticoagulant therapy. No statistically significant difference in clinical curative effect was identified between the thrombolysis and anticoagulation groups (P>0.05). Following 24 h of therapy, the improvement rates of dyspnea and revascularization in the thrombolysis group achieved statistical significance compared with those of the anticoagulation group (P<0.01 for each). The PO2 level of the thrombolysis group (81.18±5.66 mmHg) was notably higher than that of the anticoagulation group and the difference was statistically significant (P<0.01). The pulmonary arterial pressures of the thrombolysis group (51.21±6.86 mmHg) were significantly lower than those of the anticoagulation group (60.64±5.17 mmHg) (P<0.01). Furthermore, the difference between the hemorrhage rates of the two groups was statistically significant (P<0.05). Thrombolysis was shown to rapidly relieve dyspnea, reduce pulmonary arterial pressure and revascularize the embolized blood vessels. However, the hemorrhage rate of the thrombolysis group was higher than that of the anticoagulation group. The overall efficacies and fatality rates of the thrombolysis and anticoagulation groups were similar.
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FEI et al. (2013) conducted a cohort in Acute submassive pulmonary embolism (n=50). Thrombolytic therapy (urokinase) vs. Anticoagulant therapy (fraxiparine and warfarin) was evaluated on Total clinical efficacy (curative rate + excellent rate + effective rate) (p=>0.05). Thrombolytic therapy and anticoagulant therapy demonstrated similar overall clinical efficacies (92% vs 88%, P>0.05) and identical fatality rates (4%) in patients with acute submassive pulmonary embolism.
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