title: Thrombolytic therapy and mortality in patients with acute pulmonary embolism.
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.
  
  
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Center for Health Equity Research and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA. said.ibrahim2@va.gov
authors.forename: Said A
authors.initials: SA
authors.lastname: Ibrahim
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: D Scott
authors.initials: DS
authors.lastname: Obrosky
authors.forename: Ming
authors.initials: M
authors.lastname: Geng
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy
chemical_list: D000925:Anticoagulants