Underuse of Systemic Thrombolysis in Pulmonary Embolism: A Single Center Retrospective Observational Study

Introduction and objectivesAcute pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. Systemic thrombolysis is the treatment of choice in patients with high-risk PE. The aim of this study is to analyze the patients diagnosed with pulmonary embolism at the emergency department, acute treatment decisions and the main outcomes.MethodsA single-center retrospective observational study was conducted in patients with the diagnosis of PE at the emergency department over a period of 3 years, followed by a one-year period of follow-up. Reported P values below .05 indicate statistical significance.ResultsA total of 240 patients presented the diagnosis of PE, with a mean age of 69.2 (± 17.4) years. Nearly a third of patients were classified with high or intermediate-high risk PE, but systemic thrombolysis was only performed in nine patients (3.8%). Among the high-risk PE subgroup, age (P=.06), gender (P=.54) and the existence of absolute and/or relative contraindications for thrombolysis (P=.99) were not predictors of the decision of non-revascularization. At the end of the follow-up period, 23.9% of the patients reported persisting symptoms, and chronic thromboembolic pulmonary hypertension was documented in 12.8% of the patients.ConclusionsAcute treatment of pulmonary embolism is imperative to reduce mortality and prevent long-term sequelae. Systemic thrombolysis is the first line therapy in high-risk patients, but it is underused by medical population even in the absence of formal contraindications. It is necessary a new national-level model of actuation, implementing alternative strategies such as interventional ones to improve outcomes.