Clinical research studyThrombolytic Therapy in Unstable Patients with Acute Pulmonary Embolism: Saves Lives but Underused
Section snippets
Materials and Methods
Unstable patients with acute pulmonary embolism discharged from short-stay hospitals throughout the United States from 1999 to 2008 and their in-hospital mortality according to the use of thrombolytic therapy were identified from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.15
The Nationwide Inpatient Sample contains data from 5 to 8 million hospital stays from approximately 1000 hospitals. It is designed to approximate a
Results
From 1999 to 2008, 2,110,320 patients were discharged from short-stay hospitals in the United States with a diagnosis of pulmonary embolism. Among these, 72,230 (3.4%) were unstable (in shock or ventilator dependent). Among unstable patients, 21,390 (30%) received thrombolytic therapy and 50,840 (70%) did not. Associated comorbid conditions were more often present in those who did not receive thrombolytic therapy than in those who did (Table 1). The proportion of unstable patients who received
Discussion
Thrombolytic therapy in unstable patients was associated with a lower in-hospital all-cause case fatality rate and fewer deaths attributable to pulmonary embolism. Despite these reductions in case fatality rate, thrombolytic therapy was administered to only 30% of unstable patients, and the use of thrombolytic therapy in unstable patients with pulmonary embolism decreased from 1999 to 2008. Pulmonary embolectomy cannot explain the reduced use of thrombolytic therapy. Only 1.2% of unstable
Conclusions
All-cause case fatality rate and case fatality rate attributable to pulmonary embolism were lower in unstable patients with pulmonary embolism who received thrombolytic therapy than in those who did not receive thrombolytic therapy. Thrombolytic therapy was associated with a larger reduction of case fatality rate than using vena cava filters without thrombolytic therapy, and thrombolytic therapy was associated with an even lower case fatality rate when used in combination with vena cava
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Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.