Retrospective analysis of pulmonary embolism patients treated with fibrinolytic therapy in the emergency department

Introduction and objective Pulmonary embolism (PE) is one of the leading causes of in-hospital mortality, but this rate is reduced when treated. In our study, we aimed to determine the complications and evaluate the effectiveness of the treatment of fibrinolytic therapy for PE patients in emergency department (ED). Materials and Methods After the approval of the ethics committee, patients who were older than 18 years of age were enrolled in the ED of Dokuz Eylül University Hospital between 01.01.2010 and 28.08.2018 and received fibrinolytic therapy due to PE. Demographic characteristics of patients, chronic diseases, risk factors for pulmonary embolism, imaging, echocardiography (ECO) and laboratory results, symptoms' time of onset, duration of ED and hospitalization, applied fibrinolytic therapy type and dose, initial hemodynamic parameters and 4th hour of treatment, complications and treatment modalities were evaluated. The patients' troponin levels, pulmonary embolism intensity index (PESI) and thrombus location and mortality rates were compared. Results 79 patients were included in the study. The mean age of the patients was 69.3 ± 16.2 and 60.8% were female. 65 patients (82.3%) had the main pulmonary arteria occlusion while 5 patients (6.3%) had segmental and subsegmental occlusion. PESI score was 136.3 ± 52.2. 100 mg 2 hour infusion of Alteplaz was the most common fibrinolytic therapy type (63.6%). When initial vital signs and 4th hour of the treatment were evaluated, there was no difference between the mean of systolic blood pressure, diastolic blood pressure and respiratory rate, and the heart rate average was decreased at the 4th hour of treatment (104 beats / min versus 93 beats / min, p = 0.0001), oxygen saturation was increased (95% vs. 96%, p = 0.011). After the treatment, 17 patients (21.5%) developed complications and 10 required additional intervention. Factors related to complication (sex, hypotension, age, platelet count, INR level, administered subeplas dose) were examined but no statistical difference was found. Two of the 12 patients who underwent fibrinolytic therapy during cardiopulmonary resuscitation (CPR) had out-hospital arrest and only one survivied. Six patients failed to recover with CPR and three patients died within 30 days. Conclusion Complications occurred in 21.5% of the patients in our study. Factors such as gender, hypotension, age, platelet count, INR level and given dose of fibrinolytic therapy could not be identified as a risk factor for bleeding. In patients receiving fibrinolytic therapy, only improvement found in heart rate and oxygen saturation at the end of 4th hour of treatment, and we could not detect any improvement in blood pressure and respiratory rate. Keywords: Pulmonary embolism, fibrinolytic therapy, complication, emergency department, treatment effectiveness