Tuberc Respir Dis > Volume 59(5); 2005 > Article
Tuberculosis and Respiratory Diseases 2005;59(5):487-496.
DOI:    Published online November 1, 2005.
Comparison of Effect Between Thrombolysis and Anticoagulation in Major Pulmonary Thromboembolism.
Song Yi Han, Jae Kwan Song, Sang Do Lee, Chae Man Lim, Younsuck Koh, Chan Sun Park, Yeon Mok Oh, Tae Sun Shim, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, Sang Bum Hong
Divisions of Pulmonary and Critical Care Medicine and Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. METHODS: In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. RESULTS: A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHE II and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). CONCLUSION: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.
Key Words: Major pulmonary thromboembolism, Thrombolysis, Anticoagulation RV dysfunction, Shock

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