Underuse of systemic thrombolysis in pulmonary embolism: A single center retrospective observational study

Introduction and objectives

Acute pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. Systemic thrombolysis is the treatment of choice in patients with high-risk PE. The aim of this study is to analyze the patients diagnosed with pulmonary embolism at the emergency department, acute treatment decisions and the main outcomes.

Methods

A single-center retrospective observational study was conducted in patients with the diagnosis of PE at the emergency department over a period of 3 years, followed by a one-year period of follow-up. Reported P values below .05 indicate statistical significance.

Results

A total of 240 patients presented the diagnosis of PE, with a mean age of 69.2 (± 17.4) years. Nearly a third of patients were classified with high or intermediate-high risk PE, but systemic thrombolysis was only performed in nine patients (3.8%). Among the high-risk PE subgroup, age (P = .06), gender (P = .54) and the existence of absolute and/or relative contraindications for thrombolysis (P = .99) were not predictors of the decision of non-revascularization. At the end of the follow-up period, 23.9% of the patients reported persisting symptoms, and chronic thromboembolic pulmonary hypertension was documented in 12.8% of the patients.

Conclusions

Acute treatment of pulmonary embolism is imperative to reduce mortality and prevent long-term sequelae. Systemic thrombolysis is the first line therapy in high-risk patients, but it is underused by medical population even in the absence of formal contraindications. It is necessary a new national-level model of actuation, implementing alternative strategies such as interventional ones to improve outcomes.