Abstract
Study Aim
Clinical guidelines recommend fibrinolysis or embolectomy for acute massive pulmonary
embolism (PE) (MPE). However, actual therapy and outcomes of emergency department
(ED) patients with MPE have not previously been reported. We characterize the current
management of ED patients with MPE in a US registry.
Methods
A prospective, observational, multicenter registry of ED patients with confirmed PE
was conducted from 2006 to 2008. Massive PE was defined as PE with an initial systolic
blood pressure less than 90 mm Hg. We compared inpatient and 30-day mortality, bleeding
complications, and recurrent venous thromboembolism.
Results
Of 1875 patients enrolled, 58 (3.1%) had MPE. There was no difference in frequency
of parenteral anticoagulation (98.3% [95% confidence interval {CI}, 90.5-101.6] vs
98.5% [95% CI, 97.9-99.1], P = .902) between patients with and without MPE. Fibrinolytic therapy and embolectomy
were infrequently used but were used more in patients with MPE than in patients without
MPE (12.1% [95% CI, 3.7-20.5] vs 2.4% [95% CI, 1.7-3.1], P < .001, and 3.4% [95% CI, 0.0-8.1] vs 0.7% [95% CI, 0.3-1.1], P = .022, respectively). Comparison of outcomes revealed higher all-cause inpatient
mortality (13.8% [95% CI, 4.9-22.7] vs 3.0% [95% CI, 2.2-3.8], P < .001), higher risk of inpatient bleeding complications (10.3% [95% CI, 2.5-18.1]
vs 3.5% [95% CI, 2.7-4.3], P = .007), and a higher 30-day mortality (14.0% [95% CI, 4.4-23.6] vs 1.8% [95% CI,
1.2-2.4], P < .001) for patients with MPE.
Conclusions
In a contemporary registry of ED patients, MPE mortality was 4-fold higher than patients
without MPE, yet only 12% of the MPE cohort received fibrinolytic therapy. Variability
exists between the treatment of MPE and current recommendations.
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Article Info
Publication History
Published online: May 25, 2012
Accepted:
February 17,
2012
Received in revised form:
February 13,
2012
Received:
November 14,
2011
Footnotes
☆Funding sources: Grant support provided by GlaxoSmithKline Inc.
☆☆Work Previously presented, in part, at the Society for Academic Emergency Medicine Western Regional Research Forum, Park City, UT. 2009; Society for Academic Emergency Medicine Annual Meeting, New Orleans, LA, 2009.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
