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Inhospital mortality of patients with submassive pulmonary embolism submitted to thrombolytic therapy in a multicenter study

  • A Volschan1, 2,
  • PCP Sousa1, 2,
  • ML Toscano1, 2,
  • J Pantoja1, 2,
  • E Eiras1, 2,
  • G Sá1, 2,
  • M Knibel1, 2,
  • AG Macedo1, 2,
  • GM Moraes1, 2 and
  • MA Lugarinho1, 2
Critical Care20059(Suppl 2):P39

https://doi.org/10.1186/cc3583

Published: 9 June 2005

Keywords

HeparinPulmonary EmbolismMulticenter StudyVentricular DysfunctionThrombolytic Therapy

Purpose

Thrombolytic therapy for submassive pulmonary embolism (SPE) remains controversial due to the lack of evidence for mortality reduction. We compared inhospital mortality of SPE patients submitted to r-TPA, unfractioned heparin (UFH) or low-weight molecular heparin (LWMH) in a prospective multicenter study.

Methods

A multicenter cohort included 625 patients, from January 1998 to May 2003, admitted with diagnosis of pulmonary embolism confirmed by: pulmonary angiography, helical computer tomography, magnetic resonance, echocardiography or lung scan. One hundred and thirty-three patients (49% males, 68 ± 15 years old) were considered having SPE after associated acute right ventricular dysfunction on a 2D echocardiogram and an absence of arterial hypotension. Syncope and chronic cor pulmonale were the exclusion criteria. Therapy (r-TPA, UFH or LWMH) was initiated after diagnosis, at the physician's discretion.

Results

Overall inhospital mortality was 15.4%. Fifty eight patients received UFH, 35 patients had LWMH and 40 patients had r-TPA. The inhospital mortality was 19.3%, 17.6% and 10.8%, respectively (P = 0.54). In univariate analysis, a lower mortality was observed among patients with heart failure submitted to r-TPA (P = 0.008), which was non-significant in multivariate analysis (P = 0.75). There was no difference when comparing LMWH versus r-TPA (P = 0.4) and UFH versus r-TPA (P = 0.27).

Conclusion

In this non-selected SPE population, no significant difference was found among patients submitted to thrombolytic therapy when compared with heparin for inhospital mortality.

Authors’ Affiliations

(1)
Hospital Cardio Trauma e São Lucas do Rio de Janeiro, Brazil
(2)
the Estudo Multicêntrico de Embolia Pulmonar Group, Brazil

Copyright

© BioMed Central Ltd 2005

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