Long-Term Outcomes of Mortality and CTEPH in Patients With Massive/Submassive Pulmonary Embolism Treated With Thrombolytics: Retro-Prospective Analysis

Aim This study aimed to determine mortality and morbidity in patients receiving fibrinolytic therapy for massive/submassive PE and the clinical factors affecting these outcomes. Materials and Methods All patients diagnosed with massive/submassive PE who received fibrinolytic therapy (alteplase) in our clinic between 2012 and 2024 were included in the study. Patients’ medical records were retrospectively reviewed using the automation system and patient files. Results A total of 50 cases (31 women, 62%; 19 men, 38%) were included in the study. The mean age of the cases was 64±16 years (min: 21 – max: 93), and the median follow-up period was 1661 days (min: 1 – max: 4566 days). Half-dose fibrinolytic therapy was administered to 26% of cases, and full-dose therapy to 74%. The 2-day mortality rate was 10% (5/50), the 10-day mortality rate was26% (13/50), and the 30-day mortality rate was 28% (14/50). The median survival was found to be 2352 days (standard error: 304 days) for all cases who underwent reperfusion therapy. The 30-day mortality rate was significantly higher in patients receiving half-dose fibrinolytic therapy compared to those receiving full-dose therapy (53.8% vs. 18.9%, p=0.029). According to Cox regression analysis, malignancy was an independent risk factor negatively affecting survival, while obesity was a positive factor. CTEPH was detected in 28.5% (6/21) of the long-term followed cases. Conclusion The effects of factors such as malignancy, obesity, and half-dose fibrinolytic therapy on mortality and morbidity in patients undergoing thrombolytic therapy with a diagnosis of massive/submassive PE should be investigated in more comprehensive studies.