How does thrombolytic therapy affect risk of major bleeding in pulmonary embolism (PE)?

Updated: Sep 18, 2020
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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In a meta-analysis of 16 randomized studies comparing thrombolytic therapy with anticoagulation therapy in patients with pulmonary embolism, including intermediate-risk, hemodynamically stable patients with right ventricular dysfunction, Chatterjee et al found that thrombolytic therapy, as compared with standard anticoagulant therapy, reduced mortality by 47% but was associated with a 2.7-fold increase in major bleeding. [83]

The investigators also found, however, that the rate of major bleeding was not significantly increased with thrombolysis among patients younger than 65 years, whereas it more than tripled in the subgroup of patients older than 65 years. [83] Thrombolytic therapy was associated with a greater risk of intracranial hemorrhage and a lower risk of recurrent pulmonary embolism. [83]

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