The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis

Introduction/Objective. Patients with submassive (intermediate risk) pulmonary embolism (PE) represent a very heterogeneous group, whose therapeutic strategy still questions whether some groups of patients would have net clinical benefit from fibrinolytic therapy (FT). Methods. From the institutiona...

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Main Authors: Radovanović Nebojša, Radosavljević-Radovanović Mina, Marinković Jelena, Antonijević Nebojša, Dobrić Milan, Mitrović Predrag, Prodanović Maja, Matić Dragan, Lasica Ratko, Savić Lidija
Format: Article
Language:English
Published: Serbian Medical Society 2019-01-01
Series:Srpski Arhiv za Celokupno Lekarstvo
Subjects:
Online Access:http://www.doiserbia.nb.rs/img/doi/0370-8179/2019/0370-81791900115R.pdf
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author Radovanović Nebojša
Radosavljević-Radovanović Mina
Marinković Jelena
Antonijević Nebojša
Dobrić Milan
Mitrović Predrag
Prodanović Maja
Matić Dragan
Lasica Ratko
Savić Lidija
author_facet Radovanović Nebojša
Radosavljević-Radovanović Mina
Marinković Jelena
Antonijević Nebojša
Dobrić Milan
Mitrović Predrag
Prodanović Maja
Matić Dragan
Lasica Ratko
Savić Lidija
author_sort Radovanović Nebojša
collection DOAJ
description Introduction/Objective. Patients with submassive (intermediate risk) pulmonary embolism (PE) represent a very heterogeneous group, whose therapeutic strategy still questions whether some groups of patients would have net clinical benefit from fibrinolytic therapy (FT). Methods. From the institutional pulmonary embolism registry, 116 patients with submassive PE were identified, and the relation of their outcome to FT was analyzed using the propensity score (PS) adjustment. The primary endpoint was the composite of death, in-hospital cardiopulmonary deterioration, or recurrence of PE. Safety outcomes were updated TIMI non-CABG related major and minor bleeding. Results. According to Cox regression analysis, the incidence of composite endpoint was significantly lower in patients treated with FT compared to anticoagulant therapy (AT) only (PS adjusted HR 0.22; 95% CI 0.05–0.89; p = 0.039). But, when patients were stratified into four PS quartiles, only patients in the highest PS quartile that received fibrinolysis, had significantly lower composite event rate than patients treated with AT (HR 0.20; 95% CI 0.01–0.56; p = 0.016). The overall mortality of the study group was 5.2% and there was no significant difference between the treatment groups. Total bleeding was significantly more frequent in FT patients (HR 3.07; 95% CI 1.02–13.29; p = 0.047), but not the major one. Conclusion. The use of FT was associated with a better outcome compared to AT in patients with submassive PE, but the benefit was mainly driven from those with highest values of PS, i.e. with the highest baseline risk. The rate of major bleeding was not significantly increased by FT.
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spelling doaj.art-5482cb8ba4ab48eb83bdffcb77ddeabf2022-12-21T22:33:16ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792019-01-0114711-1267668210.2298/SARH190710115R0370-81791900115RThe effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysisRadovanović Nebojša0Radosavljević-Radovanović Mina1Marinković Jelena2Antonijević Nebojša3Dobrić Milan4Mitrović Predrag5Prodanović Maja6Matić Dragan7Lasica Ratko8Savić Lidija9Acute Cardiac Care Unit, Emergency center, Clinical Center of Serbia, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Department of Cardiology, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Institute of Biostatistics and Informatics, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Department of Cardiology, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Department of Cardiology, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Department of Cardiology, Belgrade, SerbiaAcute Cardiac Care Unit, Emergency center, Clinical Center of Serbia, Belgrade, SerbiaAcute Cardiac Care Unit, Emergency center, Clinical Center of Serbia, Belgrade, SerbiaAcute Cardiac Care Unit, Emergency center, Clinical Center of Serbia, Belgrade, SerbiaUniversity of Belgrade, Faculty of Medicine, Department of Cardiology, Belgrade, SerbiaIntroduction/Objective. Patients with submassive (intermediate risk) pulmonary embolism (PE) represent a very heterogeneous group, whose therapeutic strategy still questions whether some groups of patients would have net clinical benefit from fibrinolytic therapy (FT). Methods. From the institutional pulmonary embolism registry, 116 patients with submassive PE were identified, and the relation of their outcome to FT was analyzed using the propensity score (PS) adjustment. The primary endpoint was the composite of death, in-hospital cardiopulmonary deterioration, or recurrence of PE. Safety outcomes were updated TIMI non-CABG related major and minor bleeding. Results. According to Cox regression analysis, the incidence of composite endpoint was significantly lower in patients treated with FT compared to anticoagulant therapy (AT) only (PS adjusted HR 0.22; 95% CI 0.05–0.89; p = 0.039). But, when patients were stratified into four PS quartiles, only patients in the highest PS quartile that received fibrinolysis, had significantly lower composite event rate than patients treated with AT (HR 0.20; 95% CI 0.01–0.56; p = 0.016). The overall mortality of the study group was 5.2% and there was no significant difference between the treatment groups. Total bleeding was significantly more frequent in FT patients (HR 3.07; 95% CI 1.02–13.29; p = 0.047), but not the major one. Conclusion. The use of FT was associated with a better outcome compared to AT in patients with submassive PE, but the benefit was mainly driven from those with highest values of PS, i.e. with the highest baseline risk. The rate of major bleeding was not significantly increased by FT.http://www.doiserbia.nb.rs/img/doi/0370-8179/2019/0370-81791900115R.pdfpulmonary embolismintermediate riskfibrinolytic therapypropensity score
spellingShingle Radovanović Nebojša
Radosavljević-Radovanović Mina
Marinković Jelena
Antonijević Nebojša
Dobrić Milan
Mitrović Predrag
Prodanović Maja
Matić Dragan
Lasica Ratko
Savić Lidija
The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis
Srpski Arhiv za Celokupno Lekarstvo
pulmonary embolism
intermediate risk
fibrinolytic therapy
propensity score
title The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis
title_full The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis
title_fullStr The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis
title_full_unstemmed The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis
title_short The effect of fibrinolytic therapy on 30-day outcome in patients with intermediate risk pulmonary embolism - propensity score-adjusted analysis
title_sort effect of fibrinolytic therapy on 30 day outcome in patients with intermediate risk pulmonary embolism propensity score adjusted analysis
topic pulmonary embolism
intermediate risk
fibrinolytic therapy
propensity score
url http://www.doiserbia.nb.rs/img/doi/0370-8179/2019/0370-81791900115R.pdf
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