The bleeding risk in thrombolysed patients with intermediary-high risk pulmonary embolism

Introduction: Pulmonary embolism (PE) is a medical condition with increasing incidence and prevalence, due to increasing frequency of the predisposing factors. The patients presenting both echocardiographic an bi-ochemical (NT pro BNP) signs of right ventricle (RV) overload are included in intermediary-high risk cate-gory. The echocardiographic signs of RV overload are represented by the RV dilation, the lowered myocardial contraction velocity of the RV, the presence of dyskine-sia of th interventricular septum (IVS), the severity of the tricuspid regurgitation.
Methods: The 65 patients were selected from the pa-tients admitted in the Cardiology Department of the Bagdasar Arseni Emergency Hospital between 2009 – 2015. Thee inclusion criteria were: a) the first episode of acute PE; b) Both echocardiographic and biochemical markers of RV dysfunction present. Exclusion criteria:
history of PE; b) age over 80 y.o; c) cardiomyopathies with severe systolic dysfunction of the LV; d) Pre-exis-ting primary or secondary pulmonary hypertension; e) end stage neoplasia; f) medical conditions associatedwith high bleeding risk; g) Psychiatric disorders affec-ting the informed consent; h) severe anemic syndro-mes – serum haemoglobin <8g/dl.
Results: T he selected patients were divided in two groups: 28 patients in the study group – receiving both fibrinolytic anticoagulant therapy – and 37 patients in the control group – receiving only anticoagulant the-rapy. The criteria for selecting the study group patients were: 1. Absence of contraindications for thrombolysis;
Body mass index 18.5 – 29.9kg/m2; 3. Absence of se-vere renal dysfunction (Creatinine clearance >30ml/ min/m2); 4. Absence of the known allergy on t-PA. We proved the significant lowering of the haemodynamic instability rate in the study group compared to con-trol group (1: 9.33 study group vs. 1: 3.8 control group, p=0.03), but no impact on the 30-day mortality rate (1: 5.6 vs. 1: 3.08, p=0.09). The result proved the absence of a statistical significant difference between the major bleeding rates between the groups (1 major bleeding in study group vs 0 major bleedings in control group), but the bleeding severity was higher in the study group (lowering the medium haemoglobin on 5th day with 08% vs. 3.87% in the control group compared to ad-mission (p=0.04)).
Conclusions: Intermediary – high risk PE can bene-fit of the thrombolytic therapy by lowering the hae-modynamic instability rate, with no effect on mortality rate. Meanwhile, the rate of the bleeding complications can be lowered by a proper selection of the patients, taking into account the bleeding risks associated to thrombolysis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)