Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

A. Riera-Mestre; D. Jiménez; A. Muriel; J. L. Lobo; L. Moores; R. D. Yusen; I. Casado; D. Nauffal; M. Oribe; M. Monreal; Hervè Decousus; P. Prandoni; Benjamin Brenner; Raquel Barba; Pierpaolo Di Micco; Laurent Bertoletti; Manolis Papadakis; Henri Bounameaux; Marijan Bosevski; J. I. Arcelus; P. Arcos; M. Barrón; A. Blanco; J. Bosco; F. Campano; J. M. Casas; E. Cisneros; E. Chaves; F. Conget; R. Del Campo; J. Del Toro; C. Falgá; C. Fernández-Capitán; M. Ferreiro; C. Font; F. Gabriel; P. Gallego; F. García-Bragado; M. Guil; J. Gutiérrez; L. Hernández; D. Hernández-Huerta; M. J. Jaras; D. Jiménez-Castro; S. Jiménez; M. Jiménez-Gil; R. Lecumberri; L. López-Jiménez; A. Lorenzo; J. M. Luque; O. Madridano; A. Maestre; P. J. Marchena; J. J. Martín-Villasclaras; M. C. Mascareño; M. Morales; M. D. Nauffal; J. A. Nieto; M. J. Núñez; J. L. Ogea; R. Otero; J. M. Pedrajas; R. Rabuñal; M. A. Rodríguez-Dávila; V. Roldán; M. Román; P. Román; V. Rosa; S. Rubio; M. D. Ruiz; J. Ruíz; A. Ruiz-Gamietea; J. C. Sahuquillo; A. Samperiz; R. Sánchez; J. F. Sánchez Muñoz-Torrero; S. Soler; M. J. Soto; G. Tiberio; J. A. Tolodí; C. Tolosa; M. I. Torres; J. Trujillo; F. Uresandi; M. Valdés; V. Valdés; R. Valle; G. Vidal; J. Villalta; V. Zorrilla; A. Bura-Riviere; P. Debourdeau; C. Durant; D. Farge-Bancel; I. Mahe; K. Rivron-Guillot; D. Zeltser; A. Barillari; G. Barillari; M. Ciammaichella; P. Di Micco; F. Dalla Valle; R. Duce; L. Farneti; R. Maida; S. Pasca; C. Piovella; R. Poggio; R. Quintavalla; A. Schenone; E. Tiraferri; D. Tonello; A. Visonà

doi:10.1111/j.1538-7836.2012.04698.x

Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

A. Riera-Mestre, D. Jiménez^*, A. Muriel, J. L. Lobo, L. Moores, R. D. Yusen, I. Casado, D. Nauffal, M. Oribe, M. Monreal, Hervè Decousus, P. Prandoni, Benjamin Brenner, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Manolis Papadakis, Henri Bounameaux, Marijan Bosevski, J. I. ArcelusP. Arcos, M. Barrón, A. Blanco, J. Bosco, F. Campano, J. M. Casas, E. Cisneros, E. Chaves, F. Conget, R. Del Campo, J. Del Toro, C. Falgá, C. Fernández-Capitán, M. Ferreiro, C. Font, F. Gabriel, P. Gallego, F. García-Bragado, M. Guil, J. Gutiérrez, L. Hernández, D. Hernández-Huerta, M. J. Jaras, D. Jiménez-Castro, S. Jiménez, M. Jiménez-Gil, R. Lecumberri, L. López-Jiménez, A. Lorenzo, J. M. Luque, O. Madridano, A. Maestre, P. J. Marchena, J. J. Martín-Villasclaras, M. C. Mascareño, M. Morales, M. D. Nauffal, J. A. Nieto, M. J. Núñez, J. L. Ogea, R. Otero, J. M. Pedrajas, R. Rabuñal, M. A. Rodríguez-Dávila, V. Roldán, M. Román, P. Román, V. Rosa, S. Rubio, M. D. Ruiz, J. Ruíz, A. Ruiz-Gamietea, J. C. Sahuquillo, A. Samperiz, R. Sánchez, J. F. Sánchez Muñoz-Torrero, S. Soler, M. J. Soto, G. Tiberio, J. A. Tolodí, C. Tolosa, M. I. Torres, J. Trujillo, F. Uresandi, M. Valdés, V. Valdés, R. Valle, G. Vidal, J. Villalta, V. Zorrilla, A. Bura-Riviere, P. Debourdeau, C. Durant, D. Farge-Bancel, I. Mahe, K. Rivron-Guillot, D. Zeltser, A. Barillari, G. Barillari, M. Ciammaichella, P. Di Micco, F. Dalla Valle, R. Duce, L. Farneti, R. Maida, S. Pasca, C. Piovella, R. Poggio, R. Quintavalla, A. Schenone, E. Tiraferri, D. Tonello, A. Visonà

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

63 Scopus citations

Abstract

Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbólica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (<100mmHg vs. other), we used propensity score-matching for a comparison of patients who received thrombolysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n=94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P=0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n=217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P=0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.

Original language	English
Pages (from-to)	751-759
Number of pages	9
Journal	Journal of Thrombosis and Haemostasis
Volume	10
Issue number	5
DOIs	https://doi.org/10.1111/j.1538-7836.2012.04698.x
State	Published - 1 May 2012
Externally published	Yes

Keywords

Prognosis
Pulmonary embolism
Survival
Thrombolysis

Access to Document

10.1111/j.1538-7836.2012.04698.x

Cite this

Riera-Mestre, A., Jiménez, D., Muriel, A., Lobo, J. L., Moores, L., Yusen, R. D., Casado, I., Nauffal, D., Oribe, M., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Micco, P. D., Bertoletti, L., Papadakis, M., Bounameaux, H., Bosevski, M., ... Visonà, A. (2012). Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism. Journal of Thrombosis and Haemostasis, 10(5), 751-759. https://doi.org/10.1111/j.1538-7836.2012.04698.x

@article{d8768d25ddd047e2b99c44b640c48ada,

title = "Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism",

abstract = "Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmb{\'o}lica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (<100mmHg vs. other), we used propensity score-matching for a comparison of patients who received thrombolysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n=94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P=0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n=217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P=0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.",

keywords = "Prognosis, Pulmonary embolism, Survival, Thrombolysis",

author = "A. Riera-Mestre and D. Jim{\'e}nez and A. Muriel and Lobo, {J. L.} and L. Moores and Yusen, {R. D.} and I. Casado and D. Nauffal and M. Oribe and M. Monreal and Herv{\`e} Decousus and P. Prandoni and Benjamin Brenner and Raquel Barba and Micco, {Pierpaolo Di} and Laurent Bertoletti and Manolis Papadakis and Henri Bounameaux and Marijan Bosevski and Arcelus, {J. I.} and P. Arcos and M. Barr{\'o}n and A. Blanco and J. Bosco and F. Campano and Casas, {J. M.} and E. Cisneros and E. Chaves and F. Conget and {Del Campo}, R. and {Del Toro}, J. and C. Falg{\'a} and C. Fern{\'a}ndez-Capit{\'a}n and M. Ferreiro and C. Font and F. Gabriel and P. Gallego and F. Garc{\'i}a-Bragado and M. Guil and J. Guti{\'e}rrez and L. Hern{\'a}ndez and D. Hern{\'a}ndez-Huerta and Jaras, {M. J.} and D. Jim{\'e}nez-Castro and S. Jim{\'e}nez and M. Jim{\'e}nez-Gil and R. Lecumberri and L. L{\'o}pez-Jim{\'e}nez and A. Lorenzo and Luque, {J. M.} and O. Madridano and A. Maestre and Marchena, {P. J.} and Mart{\'i}n-Villasclaras, {J. J.} and Mascare{\~n}o, {M. C.} and M. Morales and Nauffal, {M. D.} and Nieto, {J. A.} and N{\'u}{\~n}ez, {M. J.} and Ogea, {J. L.} and R. Otero and Pedrajas, {J. M.} and R. Rabu{\~n}al and Rodr{\'i}guez-D{\'a}vila, {M. A.} and V. Rold{\'a}n and M. Rom{\'a}n and P. Rom{\'a}n and V. Rosa and S. Rubio and Ruiz, {M. D.} and J. Ru{\'i}z and A. Ruiz-Gamietea and Sahuquillo, {J. C.} and A. Samperiz and R. S{\'a}nchez and {S{\'a}nchez Mu{\~n}oz-Torrero}, {J. F.} and S. Soler and Soto, {M. J.} and G. Tiberio and Tolod{\'i}, {J. A.} and C. Tolosa and Torres, {M. I.} and J. Trujillo and F. Uresandi and M. Vald{\'e}s and V. Vald{\'e}s and R. Valle and G. Vidal and J. Villalta and V. Zorrilla and A. Bura-Riviere and P. Debourdeau and C. Durant and D. Farge-Bancel and I. Mahe and K. Rivron-Guillot and D. Zeltser and A. Barillari and G. Barillari and M. Ciammaichella and {Di Micco}, P. and {Dalla Valle}, F. and R. Duce and L. Farneti and R. Maida and S. Pasca and C. Piovella and R. Poggio and R. Quintavalla and A. Schenone and E. Tiraferri and D. Tonello and A. Vison{\`a}",

year = "2012",

month = may,

day = "1",

doi = "10.1111/j.1538-7836.2012.04698.x",

language = "English",

volume = "10",

pages = "751--759",

journal = "Journal of Thrombosis and Haemostasis",

issn = "1538-7933",

publisher = "WILEY-BLACKWELL PUBLISHING, INC COMMERCE PLACE, 350 MAIN ST, MALDEN 02148~…",

number = "5",

}

Riera-Mestre, A, Jiménez, D, Muriel, A, Lobo, JL, Moores, L, Yusen, RD, Casado, I, Nauffal, D, Oribe, M, Monreal, M, Decousus, H, Prandoni, P, Brenner, B, Barba, R, Micco, PD, Bertoletti, L, Papadakis, M, Bounameaux, H, Bosevski, M, Arcelus, JI, Arcos, P, Barrón, M, Blanco, A, Bosco, J, Campano, F, Casas, JM, Cisneros, E, Chaves, E, Conget, F, Del Campo, R, Del Toro, J, Falgá, C, Fernández-Capitán, C, Ferreiro, M, Font, C, Gabriel, F, Gallego, P, García-Bragado, F, Guil, M, Gutiérrez, J, Hernández, L, Hernández-Huerta, D, Jaras, MJ, Jiménez-Castro, D, Jiménez, S, Jiménez-Gil, M, Lecumberri, R, López-Jiménez, L, Lorenzo, A, Luque, JM, Madridano, O, Maestre, A, Marchena, PJ, Martín-Villasclaras, JJ, Mascareño, MC, Morales, M, Nauffal, MD, Nieto, JA, Núñez, MJ, Ogea, JL, Otero, R, Pedrajas, JM, Rabuñal, R, Rodríguez-Dávila, MA, Roldán, V, Román, M, Román, P, Rosa, V, Rubio, S, Ruiz, MD, Ruíz, J, Ruiz-Gamietea, A, Sahuquillo, JC, Samperiz, A, Sánchez, R, Sánchez Muñoz-Torrero, JF, Soler, S, Soto, MJ, Tiberio, G, Tolodí, JA, Tolosa, C, Torres, MI, Trujillo, J, Uresandi, F, Valdés, M, Valdés, V, Valle, R, Vidal, G, Villalta, J, Zorrilla, V, Bura-Riviere, A, Debourdeau, P, Durant, C, Farge-Bancel, D, Mahe, I, Rivron-Guillot, K, Zeltser, D, Barillari, A, Barillari, G, Ciammaichella, M, Di Micco, P, Dalla Valle, F, Duce, R, Farneti, L, Maida, R, Pasca, S, Piovella, C, Poggio, R, Quintavalla, R, Schenone, A, Tiraferri, E, Tonello, D & Visonà, A 2012, 'Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism', Journal of Thrombosis and Haemostasis, vol. 10, no. 5, pp. 751-759. https://doi.org/10.1111/j.1538-7836.2012.04698.x

TY - JOUR

T1 - Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

AU - Riera-Mestre, A.

AU - Jiménez, D.

AU - Muriel, A.

AU - Lobo, J. L.

AU - Moores, L.

AU - Yusen, R. D.

AU - Casado, I.

AU - Nauffal, D.

AU - Oribe, M.

AU - Monreal, M.

AU - Decousus, Hervè

AU - Prandoni, P.

AU - Brenner, Benjamin

AU - Barba, Raquel

AU - Micco, Pierpaolo Di

AU - Bertoletti, Laurent

AU - Papadakis, Manolis

AU - Bounameaux, Henri

AU - Bosevski, Marijan

AU - Arcelus, J. I.

AU - Arcos, P.

AU - Barrón, M.

AU - Blanco, A.

AU - Bosco, J.

AU - Campano, F.

AU - Casas, J. M.

AU - Cisneros, E.

AU - Chaves, E.

AU - Conget, F.

AU - Del Campo, R.

AU - Del Toro, J.

AU - Falgá, C.

AU - Fernández-Capitán, C.

AU - Ferreiro, M.

AU - Font, C.

AU - Gabriel, F.

AU - Gallego, P.

AU - García-Bragado, F.

AU - Guil, M.

AU - Gutiérrez, J.

AU - Hernández, L.

AU - Hernández-Huerta, D.

AU - Jaras, M. J.

AU - Jiménez-Castro, D.

AU - Jiménez, S.

AU - Jiménez-Gil, M.

AU - Lecumberri, R.

AU - López-Jiménez, L.

AU - Lorenzo, A.

AU - Luque, J. M.

AU - Madridano, O.

AU - Maestre, A.

AU - Marchena, P. J.

AU - Martín-Villasclaras, J. J.

AU - Mascareño, M. C.

AU - Morales, M.

AU - Nauffal, M. D.

AU - Nieto, J. A.

AU - Núñez, M. J.

AU - Ogea, J. L.

AU - Otero, R.

AU - Pedrajas, J. M.

AU - Rabuñal, R.

AU - Rodríguez-Dávila, M. A.

AU - Roldán, V.

AU - Román, M.

AU - Román, P.

AU - Rosa, V.

AU - Rubio, S.

AU - Ruiz, M. D.

AU - Ruíz, J.

AU - Ruiz-Gamietea, A.

AU - Sahuquillo, J. C.

AU - Samperiz, A.

AU - Sánchez, R.

AU - Sánchez Muñoz-Torrero, J. F.

AU - Soler, S.

AU - Soto, M. J.

AU - Tiberio, G.

AU - Tolodí, J. A.

AU - Tolosa, C.

AU - Torres, M. I.

AU - Trujillo, J.

AU - Uresandi, F.

AU - Valdés, M.

AU - Valdés, V.

AU - Valle, R.

AU - Vidal, G.

AU - Villalta, J.

AU - Zorrilla, V.

AU - Bura-Riviere, A.

AU - Debourdeau, P.

AU - Durant, C.

AU - Farge-Bancel, D.

AU - Mahe, I.

AU - Rivron-Guillot, K.

AU - Zeltser, D.

AU - Barillari, A.

AU - Barillari, G.

AU - Ciammaichella, M.

AU - Di Micco, P.

AU - Dalla Valle, F.

AU - Duce, R.

AU - Farneti, L.

AU - Maida, R.

AU - Pasca, S.

AU - Piovella, C.

AU - Poggio, R.

AU - Quintavalla, R.

AU - Schenone, A.

AU - Tiraferri, E.

AU - Tonello, D.

AU - Visonà, A.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbólica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (<100mmHg vs. other), we used propensity score-matching for a comparison of patients who received thrombolysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n=94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P=0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n=217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P=0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.

AB - Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of anticoagulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15944 patients with an objectively confirmed symptomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbólica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mortality during the first 3months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (<100mmHg vs. other), we used propensity score-matching for a comparison of patients who received thrombolysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypotension, analysis of propensity score-matched pairs (n=94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.36-1.46; P=0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n=217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P=0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.

KW - Prognosis

KW - Pulmonary embolism

KW - Survival

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=84860447123&partnerID=8YFLogxK

U2 - 10.1111/j.1538-7836.2012.04698.x

DO - 10.1111/j.1538-7836.2012.04698.x

M3 - Article

C2 - 22417297

AN - SCOPUS:84860447123

SN - 1538-7933

VL - 10

SP - 751

EP - 759

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

IS - 5

ER -

Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism

Abstract

Keywords

Access to Document

Fingerprint

Cite this