title: Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?
abstract: BACKGROUND
  Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality.
  
  
  METHODS
  We did a retrospective analysis using multi-institutional observational data from the Nationwide Inpatient Sample database. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were used to identify the patients with pulmonary embolism and right ventricular dysfunction. In-hospital mortality was defined as the primary outcome of interest.
  
  
  RESULTS
  Over the 4 years of the study period, 3668 patients with right ventricular dysfunction and pulmonary embolism were found, of which 3253 patients were identified as having hemodynamically stable right-sided heart failure with pulmonary embolism. There was no significant difference in mortality between hemodynamically stable pulmonary embolism patients with right ventricular dysfunction who received thrombolytic agents compared with those who did not. When outcomes were assessed for patients with right ventricular dysfunction and hemodynamic instability, a significant improvement in mortality was noted for patients with right ventricular dysfunction who received thrombolytic agents, which confirmed previous reports that thrombolytic therapy decreases mortality in pulmonary embolism patients who are hemodynamically unstable.
  
  
  CONCLUSIONS
  Our data support the use of less aggressive treatment for stable pulmonary embolism patients with right ventricular dysfunction. These results argue against the reflexive use of thrombolytic agents in stable pulmonary embolism patients with right ventricular dysfunction.
authors: Department of Medicine, University of Arizona Health Sciences, Tucson.
authors: Hem
authors: H
authors: Desai
authors: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona Health Sciences, Tucson. Electronic address: bnatt@deptofmed.arizona.edu.
authors: Bhupinder
authors: B
authors: Natt
authors: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona Health Sciences, Tucson.
authors: Christian
authors: C
authors: Bime
authors: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona Health Sciences, Tucson.
authors: Joshua
authors: J
authors: Dill
authors: Department of Medicine, University of Arizona Health Sciences, Tucson; Sarver Heart Center, University of Arizona Health Sciences, Tucson.
authors: James E
authors: JE
authors: Dalen
authors: Department of Medicine, University of Arizona Health Sciences, Tucson; Sarver Heart Center, University of Arizona Health Sciences, Tucson.
authors: Joseph S
authors: JS
authors: Alpert
mesh_terms: D017128:Embolectomy / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000401:mortality; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000188:drug therapy / Q000401:mortality
chemical_list: D005343:Fibrinolytic Agents
keywords: Pulmonary embolism; Right ventricular failure; Thrombolytics