title: The Use of Thrombolysis for Acute Pulmonary Embolism in the United States: National Trends and Patient Characteristics from 2006 to 2011.
abstract: BACKGROUND
  Thrombolysis for the treatment of pulmonary embolism (PE) has received significant attention in the literature over the past 10 years.
  
  
  OBJECTIVE
  Our primary objective was to examine the trend in thrombolysis use in the United States from 2006 to 2011. Secondary objectives include examining patient and hospital characteristics associated with receiving thrombolysis and rates of complications associated with thrombolysis.
  
  
  METHODS
  In this retrospective cohort study, we used the Nationwide Inpatient Sample from 2006 to 2011 to identify patients with a diagnosis of PE who received or did not receive thrombolytic agents.
  
  
  RESULTS
  Examining the records of 47,911,414 hospital discharges identified a cohort of 1,317,329 patients with PE; of these patients, 10,617 received thrombolysis. During the study period, there was a 30% relative increase in the use of thrombolysis, from 0.68% (95% confidence interval [CI] 0.64-0.73%) to 0.89% (95% CI 0.83-0.95%; p < 0.01). After controlling for all factors in the model, factors associated with decreased access to thrombolysis were increasing age (odds ratio [OR] 0.981 [95% CI 0.980-0.982]; p < 0.01), female sex (OR 0.78 [95% CI 0.75-0.81]; p < 0.01), Black race (OR 0.86 [95% CI 0.81-0.91]; p < 0.01), Hispanic race (OR 0.78 [95% CI 0.71-0.86]; p < 0.01), other race (OR 0.72 [95% CI 0.59-0.88]; p = 0.02), and rural hospital location (OR 0.48 [95% CI 0.43-0.52]; p < 0.01).
  
  
  CONCLUSIONS
  The use of thrombolysis increased between 2006 and 2011 in the United States. Patients who receive thrombolysis tend to be white men, live in higher-income ZIP codes, and receive the therapy at large academic teaching hospitals.
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada; Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
authors.forename: Barret
authors.initials: B
authors.lastname: Rush
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Katie
authors.initials: K
authors.lastname: Wiskar
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Landon
authors.initials: L
authors.lastname: Berger
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Griesdale
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends*; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents
keywords: United States; epidemiology; pulmonary embolism; thrombolysis