Thrombolysis in Acute Pulmonary Embolism : are we overdoing it?

Aim and MethodWe aimed to study the clinical data and outcome of patients admitted in our centre with acute pulmonary embolism (PE) over a five year period from May 2013 to April 2018. The main outcome data included were- in-hospital bleeding, in hospital RV function improvement, PAH improvement, duration of hospital stay, 30 and 90 day mortality. ResultsA total of 114 (69 m, 55 f) patients with the mean age of 55+/- 15 yrs were included. Patients who had involvement of central pulmonary trunk- called as "Central PE" group (n = 82) and others as "Peripheral PE" group (n = 32). There were more women in the peripheral PE group (53.1% vs 34.1%, p 0.05), while RBBB (22% vs 3.1%, p 0.02) and RV dysfunction (59.8% vs 25%, p 0.002) were noted more in the central PE group. Systemic thrombolysis was done in 53 patients (49 central, 4 peripheral), of which only 3 had hypotension and 28 patients were in the Intermediate-high risk group. The overall in-hospital, 30 day and 90 day mortality were 3.6, 13.2 and 22.8% respectively. Bleeding was significantly higher in thrombolysed group compared to the non- thrombolysed group (18.9% vs 0, p 0.0003). However, improvement in pulmonary hypertension was noted more in thrombolysis group compared to non-thrombolytic group. (49% vs 21.2%, p 0.01). ConclusionThis retrospective data from a tertiary centre in South India showed that short and mid-term mortality of patients with PE still remains high. The high non-guideline use of thrombolysis has reflected in the increased bleeding noted in our study.