Chest
Clinical Investigations: Pulmonary EmbolismThrombolytic Therapy for Pulmonary Embolism: Frequency of Intracranial Hemorrhage and Associated Risk Factors
Section snippets
MATERIALS AND METHODS
Data on 312 patients from five previously reported studies1, 2, 3, 4, 5, 6, 7 of thrombolysis in PE (as an adjunct to heparin anticoagulation) were analyzed in an overview. The first trial was a dose selection trial of recombinant tissue plasminogen activator (rt-PA) and all 47 patients received 50 to 90 mg over 2 to 6 h.1, 2, 3 The second trial was a study of 45 patients randomized to rt-PA, 100 mg over 2 h vs urokinase, 2,000 Units/lb body weight, as a bolus followed by the same dose per hour
RESULTS
The overall frequency of ICH was 6 of 312 or 1.9% (95% confidence interval [CI], 0.7 to 4.1%) (Table 1). Three patients died, two of ICH and one of recurrent PE or myocardial infarction, but no autopsies were performed. The other three were discharged from the hospital with minor residual neurologic deficits.
Patients with ICH were older (68.1±8.1 years vs 57.3±17.0 years), but this trend did not achieve statistical significance (p=0.14). No patient younger than 50 years of age suffered an ICH,
DISCUSSION
PE thrombolysis can rapidly reverse right ventricular dysfunction and can reduce the rate of recurrent PE.6 This overview demonstrates that ICH after PE thrombolysis is an infrequent but at times fatal complication. The presence of diastolic hypertension on hospital admission is associated with a higher risk of ICH. Younger patients appear to be at very low risk for thrombolysis-related ICH after PE.
The frequency of ICH after thrombolysis for PE in our series (1.9%; 95% CI, 0.7 to 4.1%) is
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