 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 September 1994 | Volume 121 Issue 5 | Pages 313-317
Objective: To assess the relative risks for bleeding with thrombolytic therapy in patients who are managed using pulmonary angiograms compared with those managed using noninvasive tests, primarily the ventilation-perfusion lung scan.
Design: A decision analysis based on data from other studies.
Methods: The risk for major bleeding in patients with pulmonary embolism who receive thrombolytic therapy after a noninvasive diagnosis was assessed from complications of thrombolytic therapy in patients with myocardial infarction, assuming that the same risk ratio for major bleeding when comparing an invasive with a noninvasive approach applied to patients with pulmonary embolism. The risk ratio was 3.3 (95% CI, 1.5 to 9.8) for major bleeding in patients with myocardial infarction. One or more major complications of pulmonary angiography occurred in 1.3% of patients (CI, 0.6% to 1.9%).
Results: The average reported risk was 14% (18 of 129 patients) (CI, 7.9% to 20.1%) for major bleeding in patients who had pulmonary angiography before receiving tissue plasminogen activator (tPA). The estimated risk was 4.2% (estimated CI, 1.4% to 9.3%) for major bleeding with tPA after a noninvasive diagnosis of pulmonary embolism. Assuming a risk of 1.3% for major complications from pulmonary angiography, a risk for major hemorrhage of 14.0% for an invasive diagnosis, and a risk of 4.2% for a noninvasive diagnosis, fewer complications would occur with noninvasive management if the prevalence of pulmonary embolism exceeded 21%.
Conclusion: Among patients with suspected pulmonary embolism who are candidates for thrombolytic therapy, it is safer to use noninvasive diagnostic tests in many patients.
Author and Article Information
From the Henry Ford Heart and Vascular Institute, Detroit, Michigan.
ARTICLE
Risks for Major Bleeding from Thrombolytic Therapy in Patients with Acute Pulmonary Embolism: Consideration of Noninvasive Management
Requests for Reprints: Paul D. Stein, MD, Henry Ford Hospital, New Center Pavilion—Room 1105, 2921 West Grand Boulevard, Detroit, MI 48202-2691.
This article has been cited by other articles:
|
|
 |
|
  Authors/Task Force Members, A. Torbicki, A. Perrier, S. Konstantinides, G. Agnelli, N. Galie, P. Pruszczyk, F. Bengel, A. J.B. Brady, D. Ferreira, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur. Heart J., September 2, 2008; 29(18): 2276 - 2315. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Wan, D. J. Quinlan, G. Agnelli, and J. W. Eikelboom Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism: A Meta-Analysis of the Randomized Controlled Trials Circulation, August 10, 2004; 110(6): 744 - 749. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Behnia and O. W. Cummings DESQUAMATIVE INTERSTITIAL PNEUMONIA MASQUERADING AS ACUTE LIFE-THREATENING PULMONARY EMBOLISM Am. J. Crit. Care., May 1, 2004; 13(3): 199 - 201. [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Wood Major Pulmonary Embolism : Review of a Pathophysiologic Approach to the Golden Hour of Hemodynamically Significant Pulmonary Embolism Chest, March 1, 2002; 121(3): 877 - 905. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J H Reid Out of hours radiological diagnosis of pulmonary embolism and deep venous thrombosis Imaging, June 1, 2001; 13(2): 124 - 129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Guidelines on diagnosis and management of acute pulmonary embolism Eur. Heart J., August 2, 2000; 21(16): 1301 - 1336. [PDF]
|
|
|
|
 |
|
 S. Z Goldhaber A contemporary approach to thrombolytic therapy for pulmonary embolism Vascular Medicine, May 1, 2000; 5(2): 115 - 123. [Abstract] [PDF]
|
|
|
|
 |
|
 V. Tapson The Diagnostic Approach to Acute Venous Thromboembolism . Clinical Practice Guideline Am. J. Respir. Crit. Care Med., September 1, 1999; 160(3): 1043 - 1066. [Full Text]
|
|
|
|
 |
|
 G. Simonneau, H. Sors, B. Charbonnier, Y. Page, J.-P. Laaban, R. Azarian, M. Laurent, J.-L. Hirsch, E. Ferrari, J.-L. Bosson, et al. A Comparison of Low-Molecular-Weight Heparin with Unfractionated Heparin for Acute Pulmonary Embolism N. Engl. J. Med., September 4, 1997; 337(10): 663 - 669. [Abstract] [Full Text] [PDF]
|
|
Article
