03 Dec 08

Thrombolytic therapy and mortality in patients with acute pulmonary embolism

Posted in Venous thromboembolism at 0:11 by Laci

By SA Ibrahim, RA Stone, DS Obrosky, M Geng, MJ Fine, D Aujesky

Arch Intern Med 2008;168:2183-2190

In the management of acute pulmonary embolism, the prevalence of thrombolytic therapy is uncertain, and its benefits compared with standard anticoagulation remain a subject of debate.

Methods
This analysis included 15 116 patient discharges with a primary diagnosis of pulmonary embolism from 186 acute care hospitals in Pennsylvania (January 2000 to November 2002). We compared propensity score–adjusted mortality between patients who received thrombolysis and those who did not, using logistic regression to model mortality within 30 days of presentation and Poisson regression to model in-hospital mortality.

Results
Of the 15 116 patient discharges, only 356 (2.4%) received thrombolytic therapy. The overall 30-day mortality rate for patients who received thrombolytic therapy was 17.4% compared with 8.6% for those who did not. The corresponding in-hospital mortality rates were 19.6 and 8.3, respectively, per 1000 person-days. However, mortality risk associated with thrombolysis varied with the propensity to receive thrombolysis: the odds ratios of 30-day mortality were 2.8 (P = .007), 3.9 (P < .001), 1.8 (P = .09), 1.0 (P = .98), and 0.7 (P = .30) for patients in the lowest to the highest quintiles of the propensity score distribution who received thrombolysis. A similar pattern was observed in the risk ratios for in-hospital death.

Conclusions
In this large sample of patients hospitalized for acute pulmonary embolism, thrombolytic therapy was used infrequently. Risk of in-hospital and 30-day mortality appears to be elevated for patients who were unlikely candidates for this therapy based on characteristics at presentation, but not for patients with a relatively high predicted probability of receiving thrombolysis.

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