Study objectives: To assess the potential benefit of
thrombolysis in patients with massive pulmonary embolism (PE) with
stable hemodynamics and right ventricular dysfunction.
Design: Retrospective, cohort study.
Setting: University-based, tertiary referral medical
Patients: One hundred fifty-three consecutive
patients with massive PE from January 1992 to December 1997 treated
with heparin or thrombolysis.
results: Massive PE was confirmed by perfusion lung scan or
pulmonary angiography. Right ventricular dysfunction was assessed by
echocardiography (right ventricular/left ventricular [RV/LV]
diastolic diameter ratio > 0.6) in all patients. In order to study a
homogeneous population, 64 patients treated with thrombolysis (group 1)
were matched on baseline RV/LV diameter ratio to 64 patients treated
with heparin (group 2). Perfusion lung scan was repeated at day 7 to
day 10. Mean relative improvement in perfusion lung scans was higher in
group 1 than group 2 (54% vs 42%, respectively). PE recurrences were
the same in both groups (4.7%; n = 3). There were no bleeding
complications and no deaths in group 2. Conversely, in group 1, 15.6%
(n = 10) of patients suffered from bleeding (4.7%; n = 3 with
intracranial bleeding) and 6.25% (n = 4) of them died.
Conclusions: The results of this monocenter registry do not
support the indication for thrombolysis in patients suffering from
massive PE with stable hemodynamics and right ventricular dysfunction.
Appropriate therapy in such patients still remains unknown. Further
prospective randomized trials should be