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KMID : 0882420130840010062
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Korean Journal of Medicine
2013 Volume.84 No. 1 p.62 ~ p.70
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Short-Term Mortality in Patients with Massive and Submassive Pulmonary Embolism Receiving Thrombolytic Therapy
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Cho Yun-Ju
Koo So-My
Bang Duk-Won
Kim Ki-Up
Uh Soo-Taek
Kim Yang-Ki
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Abstract
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Background/Aims: The mortality rate following massive and submassive pulmonary embolism (PE) remains high despite thrombolytic therapy. Although thrombolytic therapy is considered a life-saving intervention in massive PE, it is only selectively indicated in patients without hypotension who are at high risk of developing hypotension. Little is known about its clinical outcome in Korea.
Methods: We retrospectively reviewed the records of patients given thrombolytics for massive and submassive PE objectively confirmed with chest computed tomography at Soon Chun Hyang University Hospital, Seoul, Korea, from 1 January 2004 to 1 August 2011. The primary outcome of this study was 30-day mortality. Secondary outcomes were the incidence of major bleeding at 30 days, mortality at 90 days, and recurrent venous thromboembolism (VTE) at 90 days.
Results: Thrombolytic therapy was performed in 21 patients: nine with massive and 12 with submassive PE. The overall 30-day mortality rate was 24% (5/21). The mortality rate in patients with massive PE was higher than that in patients with submassive PE (44% vs. 8%, respectively; p = 0.010). Mortality rates at 90 and 30 days were identical. The estimated causes of death were right ventricular failure in four patients and fatal bleeding in one patient. The median time to death from thrombolysis was 1 day (0-13 days). Major bleeding episodes occurred in three patients (14%), including fatal bleeding in one patient. There was no recurrent VTE at 90 days.
Conclusions: Patients who underwent thrombolytic therapy for massive PE showed a higher 30-day mortality compared with patients with submassive PE.
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KEYWORD
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Pulmonary embolism, Thrombolytic therapy, Mortality, Bleeding
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