Thrombolysis in Acute Pulmonary Embolism : are we overdoing it?

Aim and Method: We aimed to study the clinical data and outcome of patients admitted in our centre with acute pulmonary embolism (PE) over a five year period from May 2013 to April 2018. The main outcome data included were- in-hospital bleeding, in hospital RV function improvement, PAH improvement, duration of hospital stay, 30 and 90 day mortality. Results: A total of 114 (69 m, 55 f) patients with the mean age of 55+/- 15 yrs were included. Patients who had involvement of central pulmonary trunk- called as Central PE group (n=82) and others as Peripheral PE group (n= 32). There were more women in the peripheral PE group (53.1% vs 34.1%, p 0.05), while RBBB (22% vs 3.1%, p 0.02) and RV dysfunction (59.8% vs 25%, p 0.002) were noted more in the central PE group. Systemic thrombolysis was done in 53 patients (49 central, 4 peripheral), of which only 3 had hypotension and 28 patients were in the Intermediate-high risk group. The overall in-hospital, 30 day and 90 day mortality were 3.6, 13.2 and 22.8% respectively. Bleeding was significantly higher in thrombolysed group compared to the non-thrombolysed group (18.9% vs 0, p 0.0003). However, improvement in pulmonary hypertension was noted more in thrombolysis group compared to non-thrombolytic group. (49% vs 21.2%, p 0.01). Conclusion: This retrospective data from a tertiary centre in South India showed that short and mid-term mortality of patients with PE still remains high. The high non-guideline use of thrombolysis has reflected in the increased bleeding noted in our study.