Safety of thrombolytic therapy in elderly patients with massive pulmonary embolism: A comparison with nonelderly patients

Abstract

Thrombolytic therapy administered for massive pulmonary embolism in patients free of contraindication yields similar results and carries a similar risk for bleeding complications in elderly compared with nonelderly patients. Limiting early invasive procedures may result in less frequent major bleeding complications.

Thrombolysis in Elderly Patients With Massive Pulmonary Embolism

“…This case corroborates previous reports of the benefit of thrombolysis in elderly patients with massive PE and the absence of a higher rate of complications than in younger patients 2,5,6 . Although the therapeutic benefit in patients with submassive PE treated with thrombolysis is controversial, in patients with massive PE and right ventricular dysfunction with hemodynamic instability, this treatment rapidly resolves the embolism and improves right ventricle function, decreasing morbidity and mortality 1–3,7,8 .…”

“…Although the therapeutic benefit in patients with submassive PE treated with thrombolysis is controversial, in patients with massive PE and right ventricular dysfunction with hemodynamic instability, this treatment rapidly resolves the embolism and improves right ventricle function, decreasing morbidity and mortality 1–3,7,8 . There are few reports on the long‐term outcome after thrombolytic therapy for massive PE, but mortality seems to be related more to preexisting morbidities than to age itself 5–8 . Serum troponin levels, N‐terminal prohormone brain natriuretic peptide and right ventricular dysfunction, measured using echocardiography or computed tomography, were also associated with high mortality 9 .…”

Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

“…In massive pulmonary embolism, lysis of thrombi can be achieved quicker with the appropriate thrombolytic therapy than with conventional heparin therapy in a patient with unstable haemodynamic condition and reduced right ventricular function [1–3]. But it needs to be administered with great caution in elderly patients due to increased risk of bleeding especially at the site of venepuncture and arterial lines [11]. …”

Acute pulmonary embolism in elderly: clinical characteristics and outcome

“…The studies on the use of thrombolytic therapy in acute pulmonary embolism have given conflicting results. Hemodynamic improvement, improved perfusion on lung scanning, and death rates have been reported similar in elderly and non-elderly patients receiving thrombolytic agents with no significant difference in major bleeding complications [16,17]. Contrary, another study has demonstrated that the risk of bleeding with pulmonary embolism thrombolysis increases with increasing age [18].…”