Mixed Results for Thrombolysis in Pulmonary Embolism — Physician’s First Watch
Mixed Results for Thrombolysis in Pulmonary Embolism
By Larry Husten
Edited by David G. Fairchild, MD, MPH
Among patients with acute pulmonary embolism (PE), thrombolytic therapy reduces mortality relative to standard anticoagulation, but at the cost of increased bleeding, a JAMA meta-analysis finds.
Researchers analyzed data from 16 randomized trials comparing thrombolysis with anticoagulation (e.g., low-molecular-weight heparin) in some 2100 patients with PE. Overall, thrombolysis was associated with a significant reduction in mortality relative to anticoagulation (3.9% vs. 2.2%), but this was accompanied by a significant increase in major bleeding (9.2% vs. 3.4%), including intracranial hemorrhage (1.46% vs. 0.19%). The increased bleeding risk was significant only among patients over age 65.
A similar pattern was observed in a large subgroup deemed to have intermediate-risk PE.
The authors say the mortality benefit of thrombolytic therapy "must be tempered" by the increased risk for major bleeding, particularly among those over age 65. They advise that risk stratification for bleeding should be performed in all PE patients, especially the elderly, to identify those at high risk for complications.
Adapted from CardioExchange.