Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?
BACKGROUND
Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality.


METHODS
We did a retrospective analysis using multi-institutional observational data from the Nationwide Inpatient Sample database. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were used to identify the patients with pulmonary embolism and right ventricular dysfunction. In-hospital mortality was defined as the primary outcome of interest.


RESULTS
Over the 4 years of the study period, 3668 patients with right ventricular dysfunction and pulmonary embolism were found, of which 3253 patients were identified as having hemodynamically stable right-sided heart failure with pulmonary embolism. There was no significant difference in mortality between hemodynamically stable pulmonary embolism patients with right ventricular dysfunction who received thrombolytic agents compared with those who did not. When outcomes were assessed for patients with right ventricular dysfunction and hemodynamic instability, a significant improvement in mortality was noted for patients with right ventricular dysfunction who received thrombolytic agents, which confirmed previous reports that thrombolytic therapy decreases mortality in pulmonary embolism patients who are hemodynamically unstable.


CONCLUSION
Our data support the use of less aggressive treatment for stable pulmonary embolism patients with right ventricular dysfunction. These results argue against the reflexive use of thrombolytic agents in stable pulmonary embolism patients with right ventricular dysfunction.
['Desai|Hem|H|', 'Natt|Bhupinder|B|', 'Bime|Christian|C|', 'Dill|Joshua|J|', 'Dalen|James E|JE|', 'Alpert|Joseph S|JS|']
D017128:Embolectomy D005260:Female D005343:Fibrinolytic Agents D006801:Humans D008297:Male D008875:Middle Aged D011655:Pulmonary Embolism D012189:Retrospective Studies D015912:Thrombolytic Therapy D016896:Treatment Outcome D018497:Ventricular Dysfunction, Right
Pulmonary embolism Thrombolytics Right ventricular failure