Clinical StudiesIncidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism
Section snippets
Patients
We retrospectively analyzed the hospital records of all patients who received recombinant tissue-type plasminogen activator for massive pulmonary embolism in our hospital between November 1988 and March 1994. All but four patients had pulmonary embolism objectively diagnosed by selective bilateral pulmonary angiography. Massive pulmonary embolism was defined by a pulmonary vascular obstruction score >20/34 (ie, >60%) according to the criteria of Miller et al (15). The four remaining patients
Results
Between 1988 and 1994, 132 consecutive adult patients received intravenous alteplase for massive pulmonary embolism. There were 57 men (43%) and 75 women with a mean age of 66 years (range: 19 to 88 years). Nineteen patients (14%) received 100 mg alteplase over 2 hours, 61 (46%) received 1 mg/kg over 10 minutes, and 52 (39%) received 0.6 mg/kg over 10 minutes.
Ten patients (8%) died during the hospital stay, including two from bleeding (one patient with intracranial bleeding, another with
Discussion
Bleeding, particularly when pulmonary angiography was performed via femoral access site, was a frequent complication of thrombolytic treatment in patients with pulmonary embolism. The 25% rate of major bleeding that we observed is somewhat greater than those reported in trials of thrombolytic treatment of patients with pulmonary embolism (12), though the 1.5% incidence of intracranial hemorrhage was similar to that recently reported (11). However, the use of different definitions of major
Conclusion
In patients with massive pulmonary embolism diagnosed invasively, the use of a superficial arm vein for performing angiography may reduce thrombolysis-induced bleeding complications. The comparability of clinical trials on thrombolysis in pulmonary embolism would benefit from the use of more reproducible methods for estimating the bleeding rate.
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