Thrombolytic therapy was strongly protective against 90-day mortality in high and intermediate-high risk pulmonary embolism (OR 0.05, p=0.022), with major bleeding occurring in only 2% of cases.
Cohort (n=114)
No
Does thrombolysis reduce mortality compared to anticoagulation alone in patients with acute high and intermediate-high risk pulmonary embolism?
In a real-world cohort of high and intermediate-high risk PE patients, thrombolysis was associated with a significant reduction in 90-day mortality (OR 0.05) and a low rate of major bleeding (2%).
Effect estimate: OR 0.05
p-value: p=0.022
Abstract Background Acute pulmonary embolism (PE) is a major cause of morbidity and mortality. While systemic thrombolysis reduces mortality in high risk PE, bleeding risk limits its use in intermediate-high-risk patients. Catheter-directed therapies and multidisciplinary Pulmonary Embolism Response Teams (PERTs) have emerged to optimize management, but real-world data remain limited. Methods We conducted a retrospective cohort study including 114 patients with acute high and intermediate-high risk PE admitted to a tertiary regional referral center between October 2023 and December 2024. Diagnosis was confirmed by CTPA or V/Q scintigraphy. Patients were classified according to 30-day mortality risk, and sPESI scores were calculated. Treatment strategies included anticoagulation, systemic thrombolysis, or catheter-directed therapy. Primary outcomes were all-cause mortality and bleeding events, defined by BARC criteria. Results The mean age was 68 years, and 88% had at least one comorbidity. Thrombolysis was administered to 27% of patients, while 73% received anticoagulation alone. Major bleeding occurred in 2% of cases. Mortality was 1% at 24 hours, 6% at 7 days, 17% at 30 days, and 25% at 90 days. Independent predictors of 90-day mortality included age, low hemoglobin, smoking burden, sPESI 2, prior stroke, and chronic kidney disease. Thrombolytic therapy was strongly protective (OR 0.05, p = 0.022). Notably, sPESI—traditionally a 30-day prognostic tool—also predicted 90-day mortality. Conclusions In this real-world cohort, comorbidities significantly worsened outcomes, while thrombolysis provided a survival benefit with very low bleeding rates. Our findings support the careful, multidisciplinary use of reperfusion therapy in selected high-risk patients and highlight the prognostic value of sPESI beyond 30 days. This abstract is funded by: none
Batum et al. (Fri,) conducted a cohort in Acute high and intermediate-high risk pulmonary embolism (n=114). Thrombolysis vs. Anticoagulation alone was evaluated on All-cause mortality and bleeding events (OR 0.05, p=0.022). Thrombolytic therapy was strongly protective against 90-day mortality in high and intermediate-high risk pulmonary embolism (OR 0.05, p=0.022), with major bleeding occurring in only 2% of cases.
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