The Impact of Thrombolytic Therapy on in-Hospital Survival in Patients with Low-Intermediate and High-Intermediate Risk Pulmonary Embolism
Edibe Betül Börklü1
, Tolga Sinan Güvenç2, Ömer Kozan3
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
2Department of Cardiology, Memorial Healthcare Group Göztepe Hospital, İstanbul, Türkiye
3Department of Cardiology, Başkent University İstanbul Hospital, İstanbul, Türkiye
Keywords: Intermediate-risk pulmonary embolism; mortality risk classification; pulmonary embolism; thrombolytic treatment.
Abstract
Objective: The thrombolytic treatment is a subject of debate in acute pulmonary embolism (APE) with an intermediate risk for adverse outcomes. Our aim is to investigate retrospectively the effects of thrombolytics on mortality and other cardiovascular outcomes in intermediate-risk APE patients with further classification into low-intermediate or high-intermediate risk groups.
Methods: The study included 227 patients diagnosed as APE. Mortality risk stratification was done according to the 2014 European Society of Cardiology guidelines on APE. The primary outcome was in-hospital death related to APE. A composite of hemodynamic deterioration, cardiogenic shock, and total mortality was defined as the composite clinical endpoint.
Results: One hundred and sixty-nine (74.4%) of patients were classified as low-intermediate risk, and 58 (25.6%) of patients were classified as high-intermediate risk. The total number of patients who received alteplase (tissue plasminogen activator) was 157 (69.2%), with no difference between both groups (p=0.97). In the low-intermediate risk group, there were no differences in primary and composite endpoints regarding to thrombolytic therapy. In the high-intermediate risk group, both total mortality and APE-related mortality were lower in patients treated with thrombolytics (p=0.025 for both).
Conclusion: Classifying patients into low-intermediate and high-intermediate risk subsets is helpful for determining patients who may benefit from thrombolytic treatment.
This study was derived from the medical specialization thesis of the lead author, titled “Orta düşük ve orta yüksek riskli pulmoner embolide trombolitik tedavinin hastane içi sağkalıma etkisinin retrospektif olarak araştırılması” [Retrospective investigation of the effect of thrombolytic therapy on in-hospital survival in low-intermediate and high-intermediate risk pulmonary embolism], completed in 2017 at Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Cite This Article: Börklü EB, Güvenç TS, Kozan Ö. The Impact of Thrombolytic Therapy on in-Hospital Survival in Patients with Low-Intermediate and HighIntermediate Risk Pulmonary Embolism. Koşuyolu Heart J 2026;29(3):181–187