Pulmonary Vascular Disease |

A Clinical Audit of Thrombolytic Therapy in Patients With Normotensive Pulmonary Embolism FREE TO VIEW

Carla Nobre, MD; Dinis Mesquita, MD; Boban Thomas, MD
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CHBM, Barreiro, Portugal

Chest. 2014;145(3_MeetingAbstracts):530A. doi:10.1378/chest.1824430
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: As the benefits of thrombolytic therapy in patients with pulmonary embolism, with a normal blood pressure and intermediate clinical risk, as determined by right ventricular dysfunction on echocardiography or elevated serum markers of cardiac necrosis, are uncertain, an audit of patients diagnosed with acute PE using MDCTPA was performed to determine the mortality and hemorrhagic complications in-hospital and at 30 days.

METHODS: The two cohorts who did (n=15) and did not receive thrombolysis (n= 20) were compared for age, heart rate, blood pressure and oxyhemoglobin saturation. MDCTPA findings suggestive of adverse clinical outcome namely central PE and an increased RV/LV diameter and RV dysfunction on echocardiography was correlated to clinical score and the use of thrombolysis. The simplified PESI score was calculated in each patient and categorized as low or higher risk. The imaging findings and the simplified PESI score were then correlated with the use of thrombolysis to determine which one (clinical or imaging parameters) had a greater influence over this in our therapeutic decision.

RESULTS: The patients who received thrombolytic therapy were younger (48.6±19.1 y vs 64.2±13.2y; p< 0.01) and had a higher heart rate (107.6±17.1 vs 91.7±17.8 bpm; p< 0.05). Although the blood pressure did not differ between the two groups, the shock index was higher in those who were thrombolysed (0.94±0.23 vs 0.70±0.20, p< 0.005). Proportionally more patients with central PE and ECG findings suggestive of PE were thrombolysed. A higher proportion of patients with a higher simplified PESI score were thrombolysed. In-hospital mortality and hemorrhagic complications at 30 days was zero in both groups.

CONCLUSIONS: Our clinical audit revealed a predilection to use thrombolysis in younger patients with higher simplified PESI scores and central PE. RV dysfunction by echocardiography did not seem to tilt the decision in favour of thrombolysis.

CLINICAL IMPLICATIONS: This retrospective analysis of thrombolytic therapy in patients with intermediate risk PE and normal BP presents a snapshot of what happens in the real world. The recent disclosure of the results of the PEITHO trial provide for the first time cogent data supporting the use of thrombolytic therapy in this subset of patients. Our findings are consonant with the findings of the PEITHO trial.

DISCLOSURE: The following authors have nothing to disclose: Carla Nobre, Dinis Mesquita, Boban Thomas

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