Clinical research studyIntracerebral Hemorrhage with Thrombolytic Therapy for Acute Pulmonary Embolism
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
References (18)
- et al.
Thrombolytic therapy for pulmonary embolismFrequency of intracranial hemorrhage and associated risk factors
Chest
(1997) - et al.
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
Lancet
(1999) - et al.
Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism
Am J Cardiol
(2006) - et al.
A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey
Chest
(2010) - et al.
Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis
Am Heart J
(1997) - et al.
Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry)
J Am Coll Cardiol
(2011) - et al.
Pulmonary thromboembolism in Asian/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census
Am J Med
(2004) - et al.
Pulmonary embolism: diagnosis, incidence, and implications
Cardiovasc Surg
(1997) - et al.
Prevalence of acute pulmonary embolism in a general hospital and at autopsy
Chest
(1995)
Cited by (38)
Neurologic complications of venous thromboembolism
2021, Handbook of Clinical NeurologyVenous thromboembolism in the elderly: A narrative review
2017, Thrombosis ResearchSuccessful systemic thrombolysis in a patient with massive pulmonary thromboembolism after prolonged cardio pulmonary and cerebral resuscitation. Case report
2016, Revista Colombiana de AnestesiologiaCurrent Controversies in Thrombolytic Use in Acute Pulmonary Embolism
2016, Journal of Emergency MedicineThrombolysis in hemodynamically stable patients with acute pulmonary embolism: A meta-analysis
2014, Thrombosis ResearchCitation Excerpt :Whether a screening for the risk of bleeding in hemodynamically stable patients with acute PE could move the benefit balance in favor of thrombolysis is unclear. Some studies have identified increasing age, diastolic hypertension, BMI > 30 Kg/m2 and invasive procedures as predictors of MB [28–32]. However, there are no validated explicit clinical prediction scores that stratify bleeding risk in patients with PE receiving thrombolysis.
Patent foramen ovale and stroke in intermediate-risk pulmonary embolism
2014, ChestCitation Excerpt :However, in all these studies, mortality was not improved, and ICH incidence was about ninefold higher in the PEITHO thrombolytic group.15 This ICH risk could be attributed to the hemorrhagic transformation of a brain paradoxical embolism, which is asymptomatic most of the time.16 A diagnosis of not only stroke but also PFO, which in the current series was associated with stroke in 30% of patients, should be taken into account when a thrombolytic treatment must be considered.1
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.