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Thrombolytic therapy and mortality in patients with acute pulmonary embolism.
- Source :
-
Archives of internal medicine [Arch Intern Med] 2008 Nov 10; Vol. 168 (20), pp. 2183-90. - Publication Year :
- 2008
-
Abstract
- Background: In the management of acute pulmonary embolism, the prevalence of thrombolytic therapy is uncertain, and its benefits compared with standard anticoagulation remain a subject of debate.<br />Methods: This analysis included 15,116 patient discharges with a primary diagnosis of pulmonary embolism from 186 acute care hospitals in Pennsylvania (January 2000 to November 2002). We compared propensity score-adjusted mortality between patients who received thrombolysis and those who did not, using logistic regression to model mortality within 30 days of presentation and Poisson regression to model in-hospital mortality.<br />Results: Of the 15,116 patient discharges, only 356 (2.4%) received thrombolytic therapy. The overall 30-day mortality rate for patients who received thrombolytic therapy was 17.4% compared with 8.6% for those who did not. The corresponding in-hospital mortality rates were 19.6 and 8.3, respectively, per 1000 person-days. However, mortality risk associated with thrombolysis varied with the propensity to receive thrombolysis: the odds ratios of 30-day mortality were 2.8 (P = .007), 3.9 (P < .001), 1.8 (P = .09), 1.0 (P = .98), and 0.7 (P = .30) for patients in the lowest to the highest quintiles of the propensity score distribution who received thrombolysis. A similar pattern was observed in the risk ratios for in-hospital death.<br />Conclusions: In this large sample of patients hospitalized for acute pulmonary embolism, thrombolytic therapy was used infrequently. Risk of in-hospital and 30-day mortality appears to be elevated for patients who were unlikely candidates for this therapy based on characteristics at presentation, but not for patients with a relatively high predicted probability of receiving thrombolysis.
Details
- Language :
- English
- ISSN :
- 1538-3679
- Volume :
- 168
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- Archives of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 19001193
- Full Text :
- https://doi.org/10.1001/archinte.168.20.2183