Thrombolysis for pulmonary embolism may lower mortality but raise bleeding risks

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 - Big Risk

Compared with anticoagulant therapy, thrombolysis appears to have a lower mortality risk and lower risk of recurrent pulmonary embolism, but it does not come without risks of its own, a study published online June 17 in JAMA determined.

Pulmonary embolism presents with more than 100,000 U.S. cases annually and as many as 25 percent of patients experience sudden death. With this in mind, the research team led by Saurav Chatterjee, MD, of St Luke’s-Roosevelt Hospital Center of the Mount Sinai Health System in New York City, explored the results of 16 pulmonary embolism studies comparing the use of thrombolysis against anticoagulant therapy. In all, 2,115 patient cases were reviewed to determine net benefits and risks of using either therapy.

Researchers found that thrombolysis had a 2.17 percent all-cause mortality rate when compared to anticoagulant therapy at 3.98 percent over a mean follow-up of 81.7 days. In addition, its use had a lower rate of recurrent pulmonary embolism (1.17 percent vs 3.04 percent).

“However, the optimism regarding this clinical advantage must be tempered by the finding of significantly increased risk of major bleeding and ICH [intracranial hemorrhage] associated with thrombolytic therapy, particularly for patients older than 65 years,” stated Chatterjee et al.

Intracranial hemorrhage rates for thrombolytic patients were about 1.46 percent vs 0.19 percent in anticoagulant therapy patients. Major bleeding occurred in 9.24 percent of thrombolysis patients, while 3.42 percent of anticoagulant patients experienced it.

This rate was significantly worse in patients 65 and older: 12.93 percent of patients in this age group experienced major bleeding when undergoing thrombolysis as opposed to 4.10 percent of patients in the anticoagulant group.

Editorialist Joshua A. Beckman, MD, of Brigham and Women’s Hospital in Boston, recommended a large trial be conducted to clarify the benefits and risks. “In the meantime, thrombolytic therapy should be individualized based on clinical presentation, comorbid conditions, and patient and physician risk tolerance,” he wrote.