Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?

Area of Science:

• Cardiology
• Pulmonary Medicine
• Critical Care Medicine

Background:

• Management of pulmonary embolism (PE) with right ventricular dysfunction (RVD) remains uncertain.
• Guidelines highlight the need for data on thrombolytic agents in stable PE patients with RVD.
• This study investigates thrombolytic therapy's impact on mortality in hemodynamically stable PE patients with RVD.

Purpose of the Study:

• To determine if thrombolytic therapy improves mortality in hemodynamically stable PE patients with RVD.
• To evaluate the current treatment strategies for PE with RVD.

Main Methods:

• Retrospective analysis of multi-institutional observational data from the Nationwide Inpatient Sample database.
• Identification of PE and RVD patients using ICD-9-CM codes.
• In-hospital mortality as the primary outcome measure.

Main Results:

• 3668 patients with PE and RVD were identified; 3253 were hemodynamically stable.
• No significant difference in mortality between stable PE patients with RVD who received thrombolytics versus those who did not.
• Hemodynamically unstable PE patients with RVD showed improved mortality with thrombolytics, confirming prior findings.

Conclusions:

• Data suggest less aggressive treatment for stable PE patients with RVD.
• Results advise against the routine use of thrombolytic agents in stable PE patients with RVD.