Clinical research study
Intracerebral Hemorrhage with Thrombolytic Therapy for Acute Pulmonary Embolism

https://doi.org/10.1016/j.amjmed.2011.06.026Get rights and content

Abstract

Background

Intracranial hemorrhage is one of the dreaded complications of thrombolytic therapy for acute pulmonary embolism. We identified patients with pulmonary embolism who may be at relatively high risk of intracerebral hemorrhage from those selected for thrombolytic therapy by their physicians and presumably thought to be of reasonable risk.

Methods

The number of patients discharged from short-stay hospitals in the United States from 1998 to 2008 with pulmonary embolism who received thrombolytic therapy and the proportion with intracerebral hemorrhage were determined from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.

Results

From 1998 to 2008, 2,237,600 patients were discharged with a diagnosis of pulmonary embolism. Among patients who received thrombolytic therapy for pulmonary embolism, the prevalence of intracerebral hemorrhage was 430 of 49,500 (0.9%). The prevalence increased linearly with age more than 10 years. Intracerebral hemorrhage was less frequent in those with a primary diagnosis of pulmonary embolism (250/39,300 [0.6%]) than in those with a secondary diagnosis (180/10,300 [1.7%], P <.0001). The prevalence of intracerebral hemorrhage was lower in patients aged 65 years or less with no kidney disease (90/16,900 [0.5%]) than in patients aged more than 65 years or with kidney disease (290/20,900 [1.4%], P <.0001). The prevalence remained lower in those with a primary diagnosis (90/23,000 [0.4%] than in those with a secondary diagnosis (50/5700 [0.9%], P <.0001).

Conclusion

The cause of intracerebral hemorrhage in patients with pulmonary embolism who receive thrombolytic therapy seems to be multifactorial and related to comorbidity and age.

Section snippets

Materials and Methods

The number of patients discharged from short-stay hospitals throughout the United States from 1998 to 2008 with pulmonary embolism who received thrombolytic therapy and the proportion with intracerebral hemorrhage were determined from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.5 The Nationwide Inpatient Sample is designed to approximate a 20% sample of US nonfederal, short-term hospitals as defined by the American

All Patients with Pulmonary Embolism

From 1998 to 2008, 2,237,600 patients were discharged from short-stay hospitals is in the United States with a diagnosis of pulmonary embolism. In Table 2, demographic characteristics are listed according to whether the diagnosis of pulmonary embolism was a primary or secondary diagnosis, whether the patients were stable or unstable, and whether they received thrombolytic therapy. The prevalence of intracerebral hemorrhage was the same in men (200/23,500 [0.9%]) and women (230/26,000 [0.9%]).

Discussion

The prevalence of intracerebral hemorrhage in patients with pulmonary embolism who received thrombolytic therapy was 0.9%. The prevalence of intracerebral hemorrhage increased with age and was lower in those with a primary diagnosis of pulmonary embolism (0.6%) than in those with a secondary diagnosis (1.7%). The prevalence of intracerebral hemorrhage in those aged 65 years or less with no kidney disease was 0.5% compared with 1.4% in those aged more than 65 years or with kidney disease. Among

Conclusions

Intracerebral hemorrhage associated with thrombolytic therapy in patients with pulmonary embolism was age related, and the prevalence was higher in those with a secondary diagnosis of pulmonary embolism than in those with a primary diagnosis. This suggests that comorbid conditions contribute to its prevalence. The prevalence of intracerebral hemorrhage was lower in those aged 65 years or less with no renal disease. However, the prevalence remained higher in those with a secondary diagnosis than

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Funding: None.

Conflict of Interest: None.

Authorship: All authors had access to the data and played a role in writing this manuscript.

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