Retrospective evaluation of prognostic factors affecting survival in high-risk and intermediate-high-risk pulmonary embolism cases

Introduction: Pulmonary embolism is a life-threatening disease that disrupts hemodynamic stability and rapid diagnosis and initiation of treatment are very crucial. Anticoagulant agents are the mainstay of treatment. Systemic thrombolytic therapy is indicated in all high-risk and selected intermediate-high-risk patients without contraindications to prevent hemodynamic instability and to correct existing instability. Objective: We aimed to analyze the prognostic factors affecting complications and mortality in patients with high-risk and intermediate-high-risk pulmonary embolism who received different doses (full and half dose) of thrombolytic therapy in our clinic. Materials and Methods: In this study, patients diagnosed with high-risk and intermediate-high-risk pulmonary embolism who were hospitalized in our clinic between 01.01.2013 and 31.12.2022 and received thrombolytic therapy were retrospectively analyzed from the hospital records. Demographic data and laboratory, computed tomography pulmonary angiography (CTPA), echocardiography findings and complications (intracranial hemorrhage, gastrointestinal hemorrhage, minor bleeding, pulmonary reembolism, chronic thromboembolic pulmonary hypertension) and mortality (30 day, 90 day and 1 year) were recorded for each patient. Results: 115 patients (47,8% males) were included in the study. Mean age was 66.25±14.77 (range 26-91). Full-dose thrombolytic therapy was given to 73 patients (63,5%) as high-risk pulmonary embolism, and half-dose thrombolytic therapy 42 patients (36,5%) as intermediate-high-risk pulmonary embolism. Mortality was found to be significantly higher in patients with pulmonary embolism who required oxygen at the time of diagnosis, who were hypotensive, and were of advanced age (p <0.001). CRP, cardiac marker (troponin /Pro- BNP), Charlson Comorbidity Indexwere found to be associated with mortality (p= 0.038, p= 0.043, p= 0,008 respectively). A statistically significant increase in mortality was found in the presence of Coronary artery disease (CAD) and Congestive heart failure (CHF) (p=0.012 and p=0.005, respectively). Complication and mortality rate between the patient groups who received half-dose or full-dose thrombolytic therapy were statistically insignificant. Conclusion: This study has found that half-dose and full-dose thrombolytic therapy were not significantly superior to each other in terms of complications. In cases of pulmonary embolism, hypotension and oxygen requirement, cardiac comorbidities and the presence of right heart dilatation in echocardiography were found to be significant prognostic factors affecting the mortality, and we suggest a comprehensive use of these parameters within the current guidelines for better management of PE. Keywords: Pulmonary Embolism, Half Dose of Thrombolytic Therapy, Mortality, Complications