Background: The place of thrombolytic therapy (TLT) in not high risk pulmonary embolism (PE) is not clearly defined.
Aims: To study the features of the use of TLT in normotensive patients with PE in real clinical practice.
Methods: Analysis data from patients with a diagnosis of PE were included in the Russian multicenter observational prospective register “SIRENA” (RusSIan REgistry of pulmoNAry embolism), admitted from 15.04.2018 to 15.04.2019. The features of management of normotensive patients with PE who received TLT (group 1) was compared to that of randomly selected gender-, and year-matched normotensive patients who did not receive TLT (group 2) (ratio, 1:1).
Results: 660 patients was enrolled in the registry, 609 of them with a lifetime confirmed diagnosis of PE. TLT was performed in 152 patients with PE (25%), of which 101 (66.2%) was normotensive. In the TLT group hospital mortality was 4 (4%) patients and 6 (5.9%) patients in group 2 (р=0,748). Floating blood clot in the veins of the lower extremities (odds ratio (ОR) 11,6, 95% confidence interval (CI) 2,22-60,60), syncope in the debut of PE (ОR 1,67, 95% CI 0,73-3,78), respiratory rate over 22 per minute (ОR 1,12, 95% CI 1,02-1,23), systolic pressure in pulmonary artery by echocardiography over 40 mm Hg (ОR 6,7; 95% CI 2,44-18,74) were independent clinical factors that significantly influence the doctor’s decision to perform thrombolysis. The probability of performing TLT decreased in the presence of history of chronic kidney disease (OR 0.1, 95% CI 0.02-0.53), surgery in the previous 12 months (OR 0.19, 95% CI 0.05-0.71), an increase of the right atrium over 45 mm Hg (OR 0.96, 95% CI 0.09-0.99). Bleeding during hospitalization was registered in 10 (9.9%) patients of group 1, including BARC 3 in 2 patients.
Conclusion(s): In real clinical practice, there is an unreasonably high frequency of TLT in normotensive patients with PE.
To cite this abstract in AMA style:
Cherepanova N, Mullova I, Pavlova T, Erlikh A, Barbarash O, Berns S, Schmidt E, Duplyakov D. Factors influencing the decision making on thrombolytic therapy in normotensive patients with pulmonary embolism: data from SIRENA registry [abstract]. https://abstracts.isth.org/abstract/factors-influencing-the-decision-making-on-thrombolytic-therapy-in-normotensive-patients-with-pulmonary-embolism-data-from-sirena-registry/. Accessed March 22, 2024.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/factors-influencing-the-decision-making-on-thrombolytic-therapy-in-normotensive-patients-with-pulmonary-embolism-data-from-sirena-registry/