Thrombolysis in Angiographically Proved Intermediate to High Risk Pulmonary Embolism

Pulmonary embolism is a common emergency in the hospital setting. Main line of treatment is anticoagulant therapy. However, patients with right ventricular dysfunction are the subgroup with increased mortality and may have better outcome with initial treatment with thrombolytic therapy. The study was done to see the outcome of thrombolytic therapy in angiographically proved patients of pulmonary embolism.We performed systemic workup of patients suspected of pulmonary embolism(PE). Diagnosis of PE was ruled out in patients with low probability of PE, as defined by Wells score and negative d dimer asssay. All patients were subjected to echocardiography. Those showing findings suggestive of PE, with right ventricular dysfunction, with or without hypotension, were subjected to pulmonary arteriography. Patients having evidence of PE were subjected to thrombolysis. Repeat angiography was done after the thrombolysis to see the effect of thrombolysis and fall in pulmonary artery pressures.:27 consecutive patients with angiographically proved PE were thrombolized. Mean age was 45.8±15.2 years. 18 were male and 9 were female. Average systolic and mean pulmonary artery pressure before thrombolysis was 71.2±14.4 and 47.5±10.5 mm Hg. Angiographic success was seen in 22 patients (81.5%). Average systolic and mean pulmonary pressure after thrombolysis was 47.1 ±21.7 and 29.4±16.5 mm Hg. Three patients with unsuccessful thrombolysis were successfully subjected to trans catheter thrombus extraction. One patient died during thrombolysis. None of the patients had major bleeding complications.Thrombolysis is effective in majority of patients with pulmonary embolism with right ventricular dysfunction. The bleeding risk is low.