Efficacy and safety of delayed thrombolytic therapy for acute massive pulmonary throboembolism

Abstract

To observe the efficacy and safety of delayed thrombolytic therapy on acute massive pulmonary thromboembolism (PTE) and discuss the influence factors. From 2009 to 2013, the clinical data of patients with acute massive pulmonary thromboembolism were analyzed retrospectively. Patients with over 14-day duration and treated with thrombolytic therapy (delayed thrombolytic group) were compared with those within 14-day duration and treated with thrombolytic therapy (normal thrombolytic group) in the same period. General conditions before treatment, case history, efficacy and the incidence of bleeding after one-week treatment were collected. The influence factors of delayed thrombolytic therapy were analyzed. Sixty two cases were collected and divided into the normal thrombolytic group with 32 cases and the delayed thrombolytic group with 30 cases. Compared with the normal thrombolytic group, the delayed thrombolytic group had a longer duration [(24.8 ± 0.9) vs.(7.2 ± 0.6)d, P<0.001], an aggravation time of (5.3 ± 0.8) d, and higher systolic pulmonary arterial pressure (SPAP) [(69 ± 4)vs. (55 ± 4)mmHg, 1 mmHg= 0.133 kPa, P= 0.016]. Ages, genders, D-Dimmer, CT subpulmonic obstruction index (CTI), brain natriuretic peptide (BNP), cardiactroponinI (TnI), PaCO₂values and PaO₂values had no statistical difference between two groups. After one-week treatment, the efficacy and the incidence of bleeding was 78% and 25% respectively in normal thrombolytic group, while they were 77% and 30% respectively in delayed thrombolytic group, and there was no significant difference between two groups (P>0.05). The single factor analysis showed that the delayed thrombolytic group had more patients with hypertension, were older and had a lower PaO₂(P<0.05 or 0.01). Multivariate logistic regression analysis did not find the predictors of delayed thrombolytic therapy (P>0.05). For acute massive PTE patients with duration over 14 days, increased D-D and new exacerbation of symptoms,delayed thrombolytic therapy had the same efficacy with the normal thrombolytic therapy. The factors for predicting efficacy need further research.