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Thrombolysis may increase mortality among unlikely candidates with pulmonary embolism
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Thrombolytic therapy increased mortality among patients hospitalized for pulmonary embolism, according to data from an analysis published in the Archives of Internal Medicine.
Researchers from the Department of Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh in Pennsylvania, and from the University of Lausanne in Switzerland, conducted an analysis to determine the prevalence of thrombolytic therapy and its benefits in patients hospitalized for acute pulmonary embolism.
The study included data for 15,116 patients with pulmonary embolism discharged from 186 acute care hospitals in Pennsylvania. The researchers predicted the probability of thrombolysis and compared data based on receipt. They modeled mortality within 30 days of presentation and in-hospital.
Three hundred fifty-six patients (2.4%) received thrombolysis. The 30-day mortality rate for these patients was 17.4% vs. 8.6% for patients who did not receive thrombolysis. In-hospital mortality was also higher among those who received thrombolysis compared with those who did not (19.6 vs. 8.3 per 1,000 person-days).
Mortality risk differed based on the patient’s propensity to receive thrombolysis, which the researchers divided into five quintiles. Patients in the lowest quintile of the propensity score distribution who received thrombolysis had an OR for 30-day mortality of 2.8 (P=.007). OR for the second-lowest quintile was 3.9 (P<.001), for the middle was 1.8 (P=.09), for the second-highest was 1.0 (P=.98) and for the highest, it was 0.7 (P=.30).
In an accompanying commentary, Daniel J. Brotman, MD, and Michael B. Streiff, MD, concluded that the findings provide a rational benchmark for “the rates of use of thrombolysis in patients with pulmonary embolism (<5% of patients with pulmonary embolism).”
“[The findings] also suggest that the rate of excess fatal bleeding associated with the judicious use of thrombolysis in clinical practice (about 2% excess in this study) is not inconsistent with those observed in the clinical trial setting,” Brotman and Streiff wrote.
Arch Intern Med. 2008;168:2183-2190.