Safety and Effectiveness of Thrombolytic Therapy Compared with Standard Anticoagulation in Subjects with Submassive Pulmonary Embolism

Abstract

Objective: Thrombolytic and anticoagulation therapy modalities are the possible treatment for submassive pulmonary embolism (PE). However, the indications are still the subject of debate. The aim of the present study was to compare the efficacies of thrombolytic and standard anticoagulation treatment modalities on mortality and also to determine the safety of thrombolytic treatment in subjects with submassive PE. Materials and Methods: Subjects with submassive PE were recruited from the intensive care unit (ICU). Demographic data, comorbidity, bedside echocardiography (ECHO) findings, treatment procedure, treatment-related side effects, and total length of stay in the hospital and ICU were collected. Control ECHO was performed 48 h after the initiation of treatment. Short-term and 1-year mortality rates were recorded. The correlation between the increased risk for major bleeding and thrombolytic treatment was assessed. Results: A total of 54 subjects were enrolled during the study period. The median age of the subjects was 66 (54–73) years. Of the 54 subjects, 18 (33.3%) underwent thrombolytic treatment, and 36 (66.7%) received standard anticoagulation therapy. Short-term and 1-year mortality rates were statistically lower in subjects who received thrombolytic therapy (p=0.02 and p=0.04, respectively). The reduction in mean pulmonary arterial pressure was significantly higher in the thrombolytic treatment group (p<0.001). Risk for major bleeding was similar between the two. Conclusion: Thrombolytic therapy may reduce the mortality rates in subjects with submassive PE without an increase in the risk of major bleeding.

Keywords

• submassive pulmonary embolism
• thrombolytic therapy
• anticoagulation treatment