Comparison of Effectiveness between Anticoagulation and Thrombolysis Therapy for Pulmonary Embolism in Patients Complicated with Shock: A Nationwide Population-Based Study.

Thrombosis and Haemostasis
Jen-Kuang LeeTien-Hsing Chen

Abstract

 This study aimed to compare the efficacy of anticoagulation therapy and thrombolytic therapy for pulmonary embolism (PE) in patients complicated with shock.  This retrospective cohort study used administrative data from Taiwan's National Health Insurance Research Database. Patients admitted due to PE who received inotropic support between January 1, 1997, and December 31, 2011, were included. To closely mimic a randomized experiment, anticoagulation and thrombolysis plus anticoagulation groups were subjected to propensity score matching (PSM) according to demographic characteristics, comorbidities, and inotropic agent dosage. The primary outcome was in-hospital mortality. The secondary outcome was 3-month mortality after discharge.  After PSM, a total of 820 patients, including 164 thrombolysis and 656 anticoagulation patients, were enrolled. The in-hospital mortality was 48.2% in the thrombolysis group and 52.4% in the anticoagulation group (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.59-1.18). Major bleeding occurred in 19 (11.6%) of the thrombolysis patients and 57 (8.7%) of the anticoagulation patients (OR 1.37, 95% CI, 0.79-2.38). The 90-day mortality rates in the thrombolysis and anticoagulation groups were 15.3...Continue Reading

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