Pulmonary Vascular Disease |

Outcomes of Thrombolysis in Patients With Pulmonary Embolism Requiring Cardiopulmonary Resuscitation (CPR) FREE TO VIEW

Shahryar Ahmad; Saqib Baig; Jawad Hussain; Rahul Nanchal; Gagan Kumar
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Medical College of Wisconsin, Milwaukee, WI

Chest. 2014;146(4_MeetingAbstracts):830A. doi:10.1378/chest.1995222
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Use of thrombolysis in acute pulmonary embolism has not been conclusively shown to improve outcomes. In a meta analysis, there was a non significant reduction in mortality in the thrombolytic group when compared to anticoagulant therapy alone. Prior studies were not large enough to answer this question. In order to get larger sample size, we used Nationwide Inpatient Sample (NIS) which is one of the largest databases in United States

METHODS: We used NIS from years 2000 to 2009 for our study. We identified the admissions with acute pulmonary embolism, CPR and usage of thrombolysis using ICD-9-CM codes. Since NIS has information about time to these procedures, we were able to identify patients with PE who underwent CPR within 48 hours of admission. The use of thrombolysis within 48 hours was similarly identified. The outcomes studied were mortality, length of hospital stay and discharge destinations. We used chi square test to compare the categorical variables and Wilcoxon rank test for continuous variables. We further constructed a multivariable logistic regression model to examine whether there was mortality difference between those who received thrombolysis and those who did not. The model adjusted for age, gender, hospital type and Charlson’s co-morbidity index. P value was kept at 0.05

RESULTS: There were 1,313,021 patients discharged with primary diagnosis of pulmonary embolism from 2000 to 2009. Of these 5354 (0.41%) underwent CPR within 48 hours of presentation and of these, 731 (13.6%) underwent thrombolysis. The in hospital mortality in those who received thrombolysis was not significantly lower than those who did not undergo thrombolysis (82.2% vs. 77.5%, p=0.20). On adjusted analysis, the odds of mortality were not significantly lower in thrombolysis group (OR 0.82; 95%CI 0.52-1.28). The length of stay was longer in those who received thrombolysis than those who did not (p=0.04). The discharges to home were not significantly different in the two groups

CONCLUSIONS: In patients with cardiac arrest after pulmonary embolism, thrombolysis did not improve mortality. There was tendency towards improved outcomes with thrombolysis, though the adjusted odds were non-significant

CLINICAL IMPLICATIONS: Patients with pulmonary embolism with cardiac arrest have high mortality and need of thrombolysis should be individualized

DISCLOSURE: The following authors have nothing to disclose: Shahryar Ahmad, Saqib Baig, Jawad Hussain, Rahul Nanchal, Gagan Kumar

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