[Comparison of efficacy and tolerability of a thrombolytic treatment with rt-PA in acute massive pulmonary embolism in the elderly and patients under 75 years of age].
BACKGROUND
Pulmonary embolism often occurs in elderly patients. However, clinical presentation and treatment of massive pulmonary embolism (PE) in the elderly have not been extensively investigated. We report the results of rt-PA bolus infusion in patients aged 75 years or more suffering from massive PE.


METHODS
Fifty-four adult patients referred to our institution with symptoms suggestive of massive PE were included in a therapeutic trial of single-chain rt-PA. Patients with a Miller angiographic score of at least 20/34 were considered for entry into the study. Patients were divided into two groups according to their age. Clinical presentation at admission, resolution of scintigraphic vascular obstruction, death rate, hemorrhagic complications, recurrent pulmonary embolism and long-term follow-up were compared between both groups.


RESULTS
Twenty-eight patients were less than 75 years old and 26 patients were aged 75 years or more. Clinical symptoms at admission were similar in both groups. The mean absolute improvement in the lung scan perfusion defect, the rate of major bleeding, and the long-term evolution were not statistically different between older and younger patients.


CONCLUSIONS
Clinical presentation and tolerance of massive PE did not differ between elderly and non-elderly patients. Old age should not preclude thrombolytic therapy in massive PE, provided there are no other contraindications for thrombolytic treatment.
Gisselbrecht
M
M
Service de médecine interne 1, hôpital Laennec, Paris, France.
Diehl
J L
JL
Meyer
G
G
Sors
H
H
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator
Comparaison de l'efficacité et de la tolérance d'un traitement thrombolytique par rt-PA dans l'embolie pulmonaire aiguë massive chez le sujet âgé et chez les moins de 75 ans.