Karsten Keller1, Lukas Hobohm1,2, Matthias Ebner3, Karl-Patrik Kresoja3,4,5, Thomas Münzel2,6, Stavros V Konstantinides1,7, Mareike Lankeit1,3,5. 1. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55129 Mainz, Germany. 2. Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, 55129 Mainz, Germany. 3. Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité-University Medicine, Augustenburger Platz 1, 13353 Berlin, Germany. 4. Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany. 5. German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. 6. German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstrasse 1, 55129 Mainz, Germany. 7. Department of Cardiology, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece.
Abstract
AIMS: Pulmonary embolism (PE) is the third most common cardiovascular cause of death; systemic thrombolysis is potentially lifesaving treatment in patients presenting with haemodynamic instability. We investigated trends in the use of systemic thrombolysis and the outcome of patients with acute PE. METHODS AND RESULTS: We analysed data on the characteristics, comorbidities, treatment, and in-hospital outcome of 885 806 PE patients in Germany between 2005 and 2015. Incidence of acute PE was 99/100 000 population/year and increased from 85/100 000 in 2005 to 109/100 000 in 2015 [β 0.32 (0.26-0.38), P < 0.001]. During the same period, in-hospital case fatality rates decreased from 20.4% to 13.9% [β -0.51 (-0.52 to -0.49), P < 0.001]. The overall proportion of patients treated with systemic thrombolysis increased from 3.1% in 2005 to 4.4% in 2015 [β 0.28 (0.25-0.31), P < 0.001]. Thrombolysis was associated with lower in-hospital mortality rates in patients with haemodynamic instability, both in those with shock not necessitating cardiopulmonary resuscitation (CPR) or mechanical ventilation [odds ratio (OR) 0.42 (0.37-0.48), P < 0.001], and in those who underwent CPR [OR 0.92 (0.87-0.97), P = 0.002]. This association was independent from age, sex, and comorbidities. However, systemic thrombolysis was administered to only 23.1% of haemodynamically unstable patients. CONCLUSION: Although the proportion of PE patients treated with systemic thrombolysis increased slightly in Germany between 2005 and 2015, only the minority of haemodynamically unstable patients currently receive this treatment. In the nationwide inpatient cohort, thrombolytic therapy was associated with reduced in-hospital mortality rates in PE patients with shock, and also in those who underwent CPR.
AIMS: Pulmonary embolism (PE) is the third most common cardiovascular cause of death; systemic thrombolysis is potentially lifesaving treatment in patients presenting with haemodynamic instability. We investigated trends in the use of systemic thrombolysis and the outcome of patients with acute PE. METHODS AND RESULTS: We analysed data on the characteristics, comorbidities, treatment, and in-hospital outcome of 885 806 PE patients in Germany between 2005 and 2015. Incidence of acute PE was 99/100 000 population/year and increased from 85/100 000 in 2005 to 109/100 000 in 2015 [β 0.32 (0.26-0.38), P < 0.001]. During the same period, in-hospital case fatality rates decreased from 20.4% to 13.9% [β -0.51 (-0.52 to -0.49), P < 0.001]. The overall proportion of patients treated with systemic thrombolysis increased from 3.1% in 2005 to 4.4% in 2015 [β 0.28 (0.25-0.31), P < 0.001]. Thrombolysis was associated with lower in-hospital mortality rates in patients with haemodynamic instability, both in those with shock not necessitating cardiopulmonary resuscitation (CPR) or mechanical ventilation [odds ratio (OR) 0.42 (0.37-0.48), P < 0.001], and in those who underwent CPR [OR 0.92 (0.87-0.97), P = 0.002]. This association was independent from age, sex, and comorbidities. However, systemic thrombolysis was administered to only 23.1% of haemodynamically unstable patients. CONCLUSION: Although the proportion of PE patients treated with systemic thrombolysis increased slightly in Germany between 2005 and 2015, only the minority of haemodynamically unstable patients currently receive this treatment. In the nationwide inpatient cohort, thrombolytic therapy was associated with reduced in-hospital mortality rates in PE patients with shock, and also in those who underwent CPR.
Authors: Hannah C Kulka; Andreas Zeller; Jürgen Fornaro; Walter A Wuillemin; Stavros Konstantinides; Michael Christ Journal: Dtsch Arztebl Int Date: 2021-09-17 Impact factor: 5.594
Authors: Jean-Pierre Iskandar; Essa Hariri; Christopher Kanaan; Nicholas Kassis; Hayaan Kamran; Denise Sese; Colin Wright; Mark Marinescu; Scott J Cameron Journal: J Thromb Thrombolysis Date: 2021-09-29 Impact factor: 2.300
Authors: Brett J Carroll; Sebastian E Beyer; Tyler Mehegan; Andrew Dicks; Abby Pribish; Andrew Locke; Anuradha Godishala; Kevin Soriano; Jaya Kanduri; Kelsey Sack; Inbar Raber; Cara Wiest; Isabel Balachandran; Mason Marcus; Louis Chu; Margaret M Hayes; Jeff L Weinstein; Kenneth A Bauer; Eric A Secemsky; Duane S Pinto Journal: Am J Med Date: 2020-05-19 Impact factor: 4.965