March 13, 2013
Researchers: Thrombolytics Should Be Used With
East Lansing, MI—Based on their recent research, Michigan State University researchers took a strong position on whether thrombolytic therapy should be used for patients with massive pulmonary embolisms.
On one hand, the drug could save the patient’s life, but, on the other hand, it also could cause life-threatening bleeding.
A new study published recently in the American Journal of Medicine makes that decision more straightforward, according to the authors.
“The message to doctors is clear: Take the chance,” said Paul D. Stein, MD, a professor in Michigan State’s Department of Osteopathic Medical Specialties. “It doesn't matter how old the patient is or what other chronic diseases the patient has. Administering the drug saves lives.”
Stein said he found in an earlier study that only about a third of unstable pulmonary embolism patients—those who are in shock or require a ventilator—received thrombolytic therapy, even though the drugs decreased the risk of dying in the hospital from 50% to 15%.
For the recent study, Stein and coauthor Fadi Matta, MD, reviewed a national database of records from more than 1,000 hospitals. In the study, only 20% of unstable patients with associated chronic conditions received the drug, compared to 80% of those without such conditions.
Patients older than 60 also were less likely to receive the treatment—only 17% of those with comorbid conditions compared to 23.4% of similar patients younger than 60. Even when comorbid conditions were not present, only 70.4% of those over 60 received the thrombolytic therapy compared to 87% of those under 60.
Yet, the researchers found, even if patients had associated chronic conditions complicating pulmonary embolism, the in-hospital death rate was 20% among those who received thrombolytic therapy, compared to 47% of those who did not get the clot-dissolving drug.
“In-hospital all-cause case fatality rate and case fatality rate attributable to pulmonary embolism in unstable patients was lower in those who received thrombolytic therapy,” the authors conclude. “Thrombolytic therapy resulted in a lower case fatality rate than using vena cava filters alone, and the combination resulted in an even lower case fatality rate. Thrombolytic therapy in combination with a vena cava filter in unstable patients with acute pulmonary embolism seems indicated.”
Stein said, “Bleeding can be severe with such drugs, but the fact is, a lot more patients die if they don't get the drug than if they do.”
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