Effectiveness of thrombolysis in patients with intermediate-risk pulmonary embolism: influence on length of hospital stay.
BACKGROUND
The effects of thrombolysis on the clinical outcome of patients with intermediate-risk pulmonary embolism (PE) are still under debate. The effect of thrombolysis on the length of stay (LOS) in hospital is unknown. The aim of this study was to identify factors associated with LOS and to investigate whether LOS is suitable to assess effectiveness of thrombolysis in patients with intermediate-risk PE.


METHODS
Data were reviewed from December 2005 until October 2009. The LOS in the intensive care unit (ICU) was expressed in hours, and total LOS was recorded in days. Total LOS was not noted in case of preterm withdrawal of therapy or death.


RESULTS
Of a total of 202 patients, 84 received alteplase plus heparin and 118 patients were treated with anticoagulants alone. Total median LOS was significantly shorter (10 vs. 12 days) in the alteplase group (P=0.005), while there was no difference in the LOS in the ICU. Age above 65 years (P=0.036) and comorbidity (P<0.001) were independent predictors for a prolonged hospital stay, whereas thrombolysis independently predicted a shorter total LOS in multivariate analysis (P=0.001). Thrombolysis has shown to be able to independently predict home discharge (P=0.029).


CONCLUSIONS
LOS is influenced by patient-related factors such as age and comorbidity. Thrombolysis may lead to a reduction of total median LOS for patients with intermediate-risk PE, possibly indicating that it is more effective than anticoagulant therapy alone in this group of patients.
Berghaus
T M
TM
Department of Cardiology, Pneumology, Intensive Care and Endocrinology, Klinikum Augsburg, Academic Teaching Hospital of the Ludwig-Maximilians-University Munich, Stenglinstrasse 2, D-86156 Augsburg, Germany. thomas.berghaus@klinikum-augsburg.de
Thilo
C
C
Bluethgen
A
A
von Scheidt
W
W
Schwaiblmair
M
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006333:Heart Failure / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D011859:Radiography; D018570:Risk Assessment; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
D015415:Biomarkers; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator