title: Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism.
abstract: BACKGROUND
  While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear.
  
  
  METHODS
  In this retrospective cohort study of 15,944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbólica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3 months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (< 100 mm Hg vs. other), we used propensity score-matching for a comparison of patients who received thrombolysis to those who did not in each subgroup.
  
  
  RESULTS
  Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n = 94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P = 0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n = 217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P = 0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy.
  
  
  CONCLUSIONS
  In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Bellvitge, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Riera-Mestre
authors.forename: D
authors.initials: D
authors.lastname: Jiménez
authors.forename: A
authors.initials: A
authors.lastname: Muriel
authors.forename: J L
authors.initials: JL
authors.lastname: Lobo
authors.forename: L
authors.initials: L
authors.lastname: Moores
authors.forename: R D
authors.initials: RD
authors.lastname: Yusen
authors.forename: I
authors.initials: I
authors.lastname: Casado
authors.forename: D
authors.initials: D
authors.lastname: Nauffal
authors.forename: M
authors.initials: M
authors.lastname: Oribe
authors.forename: M
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents