İpek Göktürk, Karataş Mehmet Baran, Onuk Tolga, Güngör Barış, Yüzbaş Burcu, Keskin Muhammed, Tanık Ozan, Oz Ahmet, Hayıroğlu Mert İlker, Bolca Osman
Cardiology Department, Siyami Ersek Cardiothoracic Surgery Center, Tıbbiye Caddesi, No: 13, Haydarpaşa, Üsküdar, İstanbul, Turkey.
J Thromb Thrombolysis. 2015 Nov;40(4):424-9. doi: 10.1007/s11239-015-1214-6.
Pulmonary embolism (PE) is a major cause of cardiovascular death. Thrombolytic therapy was shown to reduce mortality, especially in high risk patients. In elderly patients (>65 years old) with PE, thrombolytic therapy may be underused due to risk of hemorrhagic complications. In this study, we aimed to assess the effectiveness and safety of thrombolytic therapy among elderly patients with PE. 363 patients (205 subjects in study group, 158 subjects in control group) who were admitted to our hospital with PE were enrolled to the study. The patients were divided into subgroups according to their age and treatment strategy. Mortality rates and bleeding complications according to TIMI bleeding criteria in 30 days and 1-year were analyzed. In elderly patients, total mortality (7.8 vs. 20.1 %, p = 0.05) and mortality at 1-year follow-up (1.9 vs. 12.9 %, p = 0.03) was significantly lower in patients who received thrombolytic treatment. Difference in total bleeding (9.8 vs. 4.5 %, p = 0.18) and major bleeding (3.9 vs. 0.6 %, p = 0.10) in thrombolytic and non-thrombolytic groups was non-significant. Thrombolytic therapy is associated with lower mortality and acceptable bleeding complication rates in PE patients older than 65 years old.
肺栓塞（PE）是心血管死亡的主要原因。溶栓治疗已被证明可降低死亡率，尤其是在高危患者中。在老年（>65岁）PE患者中，由于出血并发症风险，溶栓治疗可能未得到充分应用。在本研究中，我们旨在评估老年PE患者溶栓治疗的有效性和安全性。363例因PE入院的患者（研究组205例，对照组158例）被纳入本研究。患者根据年龄和治疗策略分为亚组。分析了30天和1年时根据TIMI出血标准的死亡率和出血并发症。在老年患者中，接受溶栓治疗的患者总死亡率（7.8%对20.1%，p = 0.05）和1年随访时的死亡率（1.9%对12.9%，p = 0.03）显著更低。溶栓组和非溶栓组的总出血（9.8%对4.5%，p = 0.18）和大出血（3.9%对0.6%，p = 0.10）差异无统计学意义。溶栓治疗与65岁以上PE患者较低的死亡率和可接受的出血并发症发生率相关。
