Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: results from a 128-patient monocenter registry.
OBJECTIVE
To assess the potential benefit of thrombolysis in patients with massive pulmonary embolism (PE) with stable hemodynamics and right ventricular dysfunction.


METHODS
Retrospective, cohort study.


METHODS
University-based, tertiary referral medical center.


METHODS
One hundred fifty-three consecutive patients with massive PE from January 1992 to December 1997 treated with heparin or thrombolysis.


RESULTS
Massive PE was confirmed by perfusion lung scan or pulmonary angiography. Right ventricular dysfunction was assessed by echocardiography (right ventricular/left ventricular [RV/LV] diastolic diameter ratio > 0.6) in all patients. In order to study a homogeneous population, 64 patients treated with thrombolysis (group 1) were matched on baseline RV/LV diameter ratio to 64 patients treated with heparin (group 2). Perfusion lung scan was repeated at day 7 to day 10. Mean relative improvement in perfusion lung scans was higher in group 1 than group 2 (54% vs 42%, respectively). PE recurrences were the same in both groups (4.7%; n = 3). There were no bleeding complications and no deaths in group 2. Conversely, in group 1, 15.6% (n = 10) of patients suffered from bleeding (4.7%; n = 3 with intracranial bleeding) and 6.25% (n = 4) of them died.


CONCLUSIONS
The results of this monocenter registry do not support the indication for thrombolysis in patients suffering from massive PE with stable hemodynamics and right ventricular dysfunction. Appropriate therapy in such patients still remains unknown. Further prospective randomized trials should be performed.
Hamel
E
E
Intensive Care Unit and Cardiology D Department, Trousseau University Hospital, Tours, France.
Pacouret
G
G
Vincentelli
D
D
Forissier
J F
JF
Peycher
P
P
Pottier
J M
JM
Charbonnier
B
B
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004106:Dilatation; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006352:Heart Ventricles / Q000473:pathology; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011859:Radiography; D011877:Radionuclide Imaging; D012008:Recurrence; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects; D014692:Ventilation-Perfusion Ratio; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology
D005343:Fibrinolytic Agents; D006493:Heparin; D010960:Plasminogen Activators