Effectiveness of systemic thrombolysis on clinical outcomes in high-risk pulmonary embolism patients with venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study
Main finding · In-hospital mortalityResult — go to the resultRisk difference - 3.0% 95% CI - 9.6% to 3.5%Authors' conclusion
Systemic thrombolysis was not associated with reduced in-hospital mortality or increased major bleeding in the high-risk PE patients receiving VA-ECMO. However, systemic thrombolysis with monteplase was associated with increased major bleeding.
Study context
- Population
- Patients with pulmonary embolism (PE) who received venoarterial extracorporeal membrane oxygenation (VA-ECMO) on the day of admission, Japanese Diagnosis Procedure Combination inpatient database, July 2010 to March 2021
- Participants
- 1,220 eligible patients
- Exposure
- Thrombolysis vs Control
- Thrombolysisn = 432
- Outcome
- In-hospital mortality
Methodological detailsnationwide inpatient database, propensity-score inverse probability of treatment weighting
- Nationwide inpatient database
- Propensity-score inverse probability of treatment weighting
Main finding
As reported in the abstract
Risk difference
- 3.0%
95% CI - 9.6% to 3.5%
By group
Observational data: associations, not effects.
Secondary outcomes
Favorable neurological outcomes, hospital LOS, VA-ECMO duration, total hospitalization cost, blood transfusion volume
- No significant differences in the secondary outcomes
Other sensitivity and subgroup analyses
- No significant differences except for the total hospitalization cost
Safety
| Outcome | Risk difference (95% CI) | |
|---|---|---|
| Major bleeding, monteplase vs control (sensitivity analysis excluding urokinase)Significant · sensitivity analysis | 6.9% (1.7%–12.1%) | |
| −5051015Difference (linear scale) |
Major bleeding
- No significant difference between thrombolysis and control
Original publication
Effectiveness of systemic thrombolysis on clinical outcomes in high-risk pulmonary embolism patients with venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study. J Intensive Care. Published 6 February 2023. doi:10.
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