LETTER
Risks for Bleeding in Patients with Pulmonary Embolism Treated with Thrombolytic Agents
Chris Hogness
15 April 1995 | Volume 122 Issue 8 | Pages 630-632
TO THE EDITOR:
Stein and colleagues [1] used data on myocardial infarction to make an important statistical argument that bleeding caused by thrombolytic agents that were given for noninvasively diagnosed pulmonary embolism would be less than the bleeding after a diagnosis established by an invasive (angiographic) procedure. However, they do not adequately discuss the potential problems of comparing apples with oranges.
The risk ratio for bleeding events when invasive compared with noninvasive methods are used after myocardial infarction might be different than the same ratio after pulmonary embolism. Venous pressures may be higher after a massive pulmonary embolus, which could increase the risk for bleeding from cannulation of a central vein relatively more than it would increase the risk after cannulation in patients with myocardial infarction. The underlying illness associated with pulmonary embolism, including not only recent surgery (which the authors note) but also underlying malignancy, may increase the risk for bleeding with either diagnostic approach and thus may decrease the relative difference. The authors fail to discuss the implications of such problems on their underlying methods.
1. Stein PD, Hull RD, Raskob G. Risks for major bleeding from thrombolytic therapy in patients with acute pulmonary embolism. Consideration of noninvasive management. Ann Intern Med. 1994; 121:313-7.
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