Thrombolytic Therapy in Intermediate High-Risk Pulmonary Embolism: Safety and Outcomes

Abstract

<bold>Introduction:</bold> Patients with intermediate high-risk pulmonary embolism (IHR-PE) present an ongoing debate regarding thrombolytic therapy. <bold>Aim:</bold> To evaluate the safety of thrombolytic therapy and the impact on in hospital mortality. To determine changing in cardiac ultrasound findings 30 days after discharge in patients with IHR-PE. <bold>Methods:</bold> A retrospective study conducted between 2014 and 2020 in the intensive care unit of cardiology department. All patients diagnosed with IHR-PE were included in the study and were categorized in two groups: G1, which received thrombolytic therapy, and G2, which received standard anticoagulation. The primary endpoint was in-hospital mortality, and the secondary endpoint was hemorrhagic complications and cardiac ultrasound finding at day 30. <bold>Results:</bold> IHR-PE was diagnosed in 39 patients, among them 22 (56.4%) patients received thrombolytic therapy. Mean age was 54 ±14years in G1vs 80±6 years in G2 with p=0.01. In G1, 90.9% have right ventricular dysfunction, with pulmonary arterial hypertension in 81.8%, and thrombus in 18.2% of cases. In hospital mortality rate was lower in the G1vs G2 in 4.5% vs 23.5% respectively with p=0.068. Minor bleeding incidents occurrence was reported in G1 and G2 in respectively 22.7% and 17.6% without significant difference (p=0.6). Only one case of major bleeding was reported in G1. Cardiac ultrasound findings at day 30 after discharge check-up: residual right ventricular dilatation or dysfunction, pulmonary arterial hypertension was only observed in the G2 with p=0.001. <bold>Conclusion:</bold> In IHR- PE, thrombolytic therapy is as safe as anticoagulation therapy. It improves right ventricular function without significant impact on mortality.