Comparison of effectiveness between anticoagulation and thrombolysis therapy for pulmonary embolism in patients complicated with shock: A nationwide population-based study
Journal
Thrombosis and Haemostasis
Journal Volume
120
Journal Issue
8
Pages
1208-1216
Date Issued
2020
Author(s)
Abstract
Objective This study aimed to compare the efficacy of anticoagulation therapy and thrombolytic therapy for pulmonary embolism (PE) in patients complicated with shock. Methods 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. Results 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% (13 patients) and 17.6% (55 patients), respectively; this difference was not significant (hazard ratio 0.88, 95% CI 0.48-1.61). Conclusion In PE patients complicated with shock, anticoagulation therapy provides similar treatment efficacy to thrombolytic therapy in terms of in-hospital and 90-day mortality. The bleeding risk was also similar in the two treatment groups. ? 2020 Georg Thieme Verlag. All rights reserved.
Subjects
cardiogenic shock; National Health Insurance Research Database; pulmonary embolism; thrombolytic therapy
SDGs
Other Subjects
dalteparin; dopamine; enoxaparin; epinephrine; heparin; inotropic agent; nadroparin; noradrenalin; streptokinase; tissue plasminogen activator; urokinase; anticoagulant agent; fibrinolytic agent; adult; aged; anticoagulation; Article; atrial fibrillation; autoimmune disease; bleeding; blood clot lysis; chronic kidney failure; cohort analysis; diabetes mellitus; heart failure; hospital mortality; human; hypertension; ischemic heart disease; lung embolism; lymphoma; male; outcome assessment; population research; propensity score; prospective study; randomized controlled trial (topic); retrospective study; thromboembolism; venous thromboembolism; adverse event; bleeding; cause of death; comorbidity; comparative study; complication; epidemiology; factual database; female; fibrinolytic therapy; follow up; intensive care unit; length of stay; lung embolism; middle aged; mortality; shock; Taiwan; treatment outcome; very elderly; Aged; Aged, 80 and over; Anticoagulants; Cause of Death; Comorbidity; Databases, Factual; Female; Fibrinolytic Agents; Follow-Up Studies; Hemorrhage; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Mortality; Pulmonary Embolism; Retrospective Studies; Shock; Taiwan; Thrombolytic Therapy; Treatment Outcome
Publisher
Georg Thieme Verlag
Type
journal article