Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service
Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administr...
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doaj-64ee0c225beb4256b25938bfea3a729b2020-11-24T21:25:55ZengWileyKaohsiung Journal of Medical Sciences1607-551X2016-11-01321157257810.1016/j.kjms.2016.09.004Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency serviceİnan Beydilli0Fevzi Yılmaz1Bedriye Müge Sönmez2Nalan Kozacı3Akar Yılmaz4İbrahim Halil Toksul5Ramazan Güven6Mustafa Avcı7Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, TurkeyDepartment of Emergency Medicine, Antalya Education and Research Hospital, Antalya, TurkeyDepartment of Emergency Medicine, Antalya Education and Research Hospital, Antalya, TurkeyDepartment of Emergency Medicine, Antalya Education and Research Hospital, Antalya, TurkeyDepartment of Cardiology, İzmir University Faculty of Medicine, İzmir, TurkeyDepartment of Emergency Medicine, Antalya Education and Research Hospital, Antalya, TurkeyDepartment of Emergency Medicine, Bitlis State Hospital, Bitlis, TurkeyDepartment of Emergency Medicine, Antalya Education and Research Hospital, Antalya, TurkeyAcute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668–0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818–2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving.http://www.sciencedirect.com/science/article/pii/S1607551X16302571EchocardiographyThromboembolismThrombolytic agent |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
İnan Beydilli Fevzi Yılmaz Bedriye Müge Sönmez Nalan Kozacı Akar Yılmaz İbrahim Halil Toksul Ramazan Güven Mustafa Avcı |
spellingShingle |
İnan Beydilli Fevzi Yılmaz Bedriye Müge Sönmez Nalan Kozacı Akar Yılmaz İbrahim Halil Toksul Ramazan Güven Mustafa Avcı Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service Kaohsiung Journal of Medical Sciences Echocardiography Thromboembolism Thrombolytic agent |
author_facet |
İnan Beydilli Fevzi Yılmaz Bedriye Müge Sönmez Nalan Kozacı Akar Yılmaz İbrahim Halil Toksul Ramazan Güven Mustafa Avcı |
author_sort |
İnan Beydilli |
title |
Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service |
title_short |
Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service |
title_full |
Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service |
title_fullStr |
Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service |
title_full_unstemmed |
Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service |
title_sort |
thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service |
publisher |
Wiley |
series |
Kaohsiung Journal of Medical Sciences |
issn |
1607-551X |
publishDate |
2016-11-01 |
description |
Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668–0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818–2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving. |
topic |
Echocardiography Thromboembolism Thrombolytic agent |
url |
http://www.sciencedirect.com/science/article/pii/S1607551X16302571 |
work_keys_str_mv |
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