Medicine of the Future in America

Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism: Statistical Analysis

Other important bleeding events, which was defined as a fall of 10% in hematocrit, were also recorded. Patients with symptoms suggesting PE and with new filling defects seen on spiral CT scan or pulmonary angiogram were interpreted as having recurrent PE.
Follow-up data were obtained during hospital readmission, during scheduled patient consultations to the department, or from a standardized questionnaire sent to the attending physician and/or cardiologist. Adverse outcomes included death, recurrent phlebitis, recurrent PE, development of congestive heart failure (CHF), or change of New York Heart Association (NYHA) functional class to class III or IV. Hospital records and the death certificates of patients who died during the follow-up period were also reviewed. Follow-up was concluded in March 2005. review

Continuous variables are expressed as the mean ± SD; categoric variables are expressed as a percentage. Nonparametric Wilcoxon test and Fisher exact test were used for the comparison of continuous and categoric variables, respectively. Associations between variables and adverse clinical events were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). All tests were two-sided, and a p value of < 0.05 was considered to be significant. Analyses were performed with a statistical software package (BMDP; BMDP Statistical Software, Inc; Los Angeles, CA). From January 1995 to January 2005, 1,876 consecutive patients were referred to the cardiology department with confirmed PE, of whom 488 (26%) were treated with thrombolytic therapy. At 24 to 36 h, thrombolysis was considered to be unsuccessful in 40 (8.2%) patients, of whom 37 had both persistent clinical instability and echocardiographic findings of RV dysfunction, and 3 patients experienced early echocardiographic deterioration following initial thrombolysis. Two eligible patients were excluded from the analysis because they experienced fatal cardiac arrest following the initial thrombolysis and had received repeat thrombolysis only as a treatment of last resort in clinically desperate circumstances.

This entry was posted in Pulmonary function and tagged embolism, surgery, thrombolysis.
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