Pulmonary embolism (PE) is considered to be a major cause of mortality, morbidity and hospitalization in Europe. Haemodynamic benefits of thrombolysis in patients with shock and hypotension are undeniable, but the role of thrombolytic therapy on the outcome of haemodynamically stable patients still remains controversial.
This is a retrospective analysis of patients with acute PE treated with thrombolytic therapy in medical intensive care unit (ICU), University Hospital Sveti Duh, between March 2014 and April 2015 .
Twenty two of 75 (29%) patients with PE received thrombolytic therapy. The mean age of patients was 63 years, 45% were male and 55% female. The major symptoms were: dyspnea (73%), chest pain (18%) and syncope (9%). 27% of patients receiving thrombolytic therapy were haemodynamically unstable and 73% were stable. All patients had an extensive clot burden on computed tomographic pulmonary angiography (CTPA). All haemodynamically stable patients had echocardiographic signs of right ventricular (RV) dysfunction. Troponin I was positive in all haemodynamically unstable patients and in 50% of haemodynamically stable patients. Only one (5%) haemodynamically unstable patient died but not because of PE or therapy complication. All other patients survived and recovered completely. Two patients (9%) had major non-intracranial bleeding complications, which were successfully treated with supportive therapy.
Key words: pulmonary embolism, thrombolytic therapy, right ventricular dysfunction, bleeding