title: Contribution of fibrinolysis to the physical component summary of the SF-36 after acute submassive pulmonary embolism.
abstract: Acute pulmonary embolism (PE) can diminish patient quality of life (QoL). The objective was to test whether treatment with tenecteplase has an independent effect on a measurement that reflects QoL in patients with submassive PE. This was a secondary analysis of an 8-center, prospective randomized controlled trial, utilizing multivariate regression to control for predefined predictors of worsened QoL including: age, active malignancy, history of PE or deep venous thrombosis (DVT), recurrent PE or DVT, chronic obstructive pulmonary disease and heart failure. QoL was measured with the physical component summary (PCS) of the SF-36. Analysis included 76 patients (37 randomized to tenecteplase, 39 to placebo). Multivariate regression yielded an equation f(8, 67), P < 0.001, with R(2) = 0.303. Obesity had the largest effect on PCS (β = -8.6, P < 0.001), with tenecteplase second (β = 4.73, P = 0.056). After controlling for all interactions, tenecteplase increased the PCS by +5.37 points (P = 0.027). In patients without any of the defined comorbidities, the coefficient on the tenecteplase variable was not significant (-0.835, P = 0.777). In patients with submassive PE, obesity had the greatest influence on QoL, followed by use of fibrinolysis. Fibrinolysis had a marginal independent effect on patient QoL after controlling for comorbidities, but was not significant in patients without comorbid conditions.
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA, laustewa@iupui.edu.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Stewart
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Peitz
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Nordenholz
authors.forename: D Mark
authors.initials: DM
authors.lastname: Courtney
authors.forename: Christopher
authors.initials: C
authors.lastname: Kabrhel
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rondina
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: James R
authors.initials: JR
authors.lastname: Klinger
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000188:drug therapy*; D011788:Quality of Life; D012307:Risk Factors; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase