Effectiveness and safety of thrombolytic therapy in elderly patients with pulmonary embolism.

Pulmonary embolism (PE) is a major cause of cardiovascular death. Thrombolytic therapy was shown to reduce mortality, especially in high risk patients. In elderly patients (>65 years old) with PE, thrombolytic therapy may be underused due to risk of hemorrhagic complications. In this study, we aimed to assess the effectiveness and safety of thrombolytic therapy among elderly patients with PE. 363 patients (205 subjects in study group, 158 subjects in control group) who were admitted to our hospital with PE were enrolled to the study. The patients were divided into subgroups according to their age and treatment strategy. Mortality rates and bleeding complications according to TIMI bleeding criteria in 30 days and 1-year were analyzed. In elderly patients, total mortality (7.8 vs. 20.1 %, p = 0.05) and mortality at 1-year follow-up (1.9 vs. 12.9 %, p = 0.03) was significantly lower in patients who received thrombolytic treatment. Difference in total bleeding (9.8 vs. 4.5 %, p = 0.18) and major bleeding (3.9 vs. 0.6 %, p = 0.10) in thrombolytic and non-thrombolytic groups was non-significant. Thrombolytic therapy is associated with lower mortality and acceptable bleeding complication rates in PE patients older than 65 years old.