title: Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism.
abstract: One hundred four patients at Brigham and Women's Hospital who received alteplase for acute pulmonary embolism were evaluated. Major bleeding occurred in 20 patients (19.2%). The principal site of bleeding was unknown in 9 (45.0%), gastrointestinal in 6 (30.0%), retroperitoneal in 3 (15.0%), intracranial in 1 (5.0%), and splenic in 1 (5.0%). Independent predictors of major hemorrhage were the administration of catecholamines for systemic arterial hypotension (odds ratio [OR] 115, 95% confidence interval [CI] 9.4 to 1,410.9, p < 0.001), cancer (OR 16.0, 95% CI 3.2 to 80, p = 0.004), diabetes mellitus (OR 9.6, 95% CI 1.7 to 54, p = 0.010), and elevated international normalized ratio before fibrinolysis (OR 5.8, 95% CI 1.5 to 22, p = 0.012).
authors.affiliation: Department of Pharmacy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Fiumara
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D048909:Diabetes Complications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology; D006470:Hemorrhage / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012307:Risk Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator