Effect of thrombolytic therapy in mortality of elderly patients with cancer and massive pulmonary embolism

Introduction

Massive pulmonary embolism (MPE) is associated with high mortality, particularly in cancer patients aged 65 years and older. Thrombolytic therapy (TT) is a life-saving intervention in pulmonary embolism, yet its efficacy and safety in this vulnerable population remain uncertain. This study aimed to evaluate the impact of thrombolytic therapy on mortality in elderly cancer patients diagnosed with MPE.

Materials and methods

This retrospective study included 90 patients aged ≥ 65 years diagnosed with MPE. Patients were categorized based on malignancy status and administration of TT. Clinical, laboratory, and echocardiographic parameters were compared. One-month all-cause mortality was recorded for each patient.

Results

Patients with malignancy exhibited higher mortality rates compared to non-malignant cases (63.3% vs. 46.7%, p = 0.1), though bleeding rates were similar between the two groups. Among cancer patients, the administration of TT did not significantly affect mortality (60% vs. 65%, p = 0.7). Right ventricular function, assessed by RV systolic motion and TAPSE, was more severely impaired in cancer patients, and TT did not lead to significant improvement in these parameters.

Conclusion

Thrombolytic therapy in elderly cancer patients with massive pulmonary embolism does not significantly reduce 1-month mortality. However, it does not increase bleeding complications, suggesting that it may be a viable option for selected patients. The similar mortality rates between thrombolytic therapy and non-thrombolytic therapy groups highlight the complex interplay between malignancy, coagulation, and cardiovascular risk. These findings emphasize the need for individualized risk assessment and treatment decisions.