Evaluation of the effect of clinical scoring systems on thrombolytic treatment decision in intermediate-risk pulmonary embolism patients

Submassive pulmonary embolism constitutes a controversial group in the treatment selection of acute pulmonary embolism. Patients in the intermediate-risk group are hemodynamically stable. They are categorized into intermediate-low and intermediate-high risk groups based on the presence of right ventricular dysfunction findings and/or elevated cardiac biomarkers. Patients in the intermediate-high risk group require close hemodynamic monitoring as they may progress to massive pulmonary embolism. If hemodynamic deterioration occurs, these patients should receive reperfusion therapy. Normotensive but clinically unstable patients are also considered for reperfusion therapy. Our study included 43 patients diagnosed with intermediate-risk pulmonary embolism who were admitted to the Chest Diseases clinic of Trakya University Faculty of Medicine Hospital between November 2022 and December 2024, and they were evaluated prospectively. Of the patients included in the study, 35 (81.4%) had intermediate-high risk pulmonary embolism, and eight (18.6%) had intermediate-low risk pulmonary embolism. Ten of our patients (23.3%) received thrombolytic therapy. Three patients received full-dose, five patients received half-dose, and two patients received catheter-directed thrombolytic therapy. In patients who received thrombolytic therapy, the Wells, simplified Wells, modified Geneva, simplified Geneva, Pulmonary Embolism Severity Index, simple Pulmonary Embolism Severity Index, and Bova scores, which evaluate diagnostic probability and mortality risk, were compared with patients who did not receive thrombolytic therapy. No statistically significant difference was found (p>0.05). Among laboratory parameters, a significant difference was observed between the two groups for troponin I and fibrinogen values (p<0.05). No significant difference was found for the scores, which evaluate bleeding risk (p>0.05). Based on the results of our study, while clinical scoring systems are useful at the diagnostic stage, their effectiveness on treatment is unknown, and more comprehensive studies are needed in this regard. Keywords: clinical scoring systems, intermediate risk pulmonary embolism, risk stratification, submassive pulmonary embolism, thrombolytic therapy