Predictors of In‐Hospital and Long‐Term Clinical Outcome in Elderly Patients with Massive Pulmonary Embolism Receiving Thrombolytic Therapy

Abstract

Higher cTn-I serum levels in the acute phase and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital mortality in elderly patients with massive PE. In the same setting, historical findings of cancer and cardiovascular disease are strong predictors of death in the long term.

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

“…Anatomical obstruction of pulmonary arteries is undoubtedly the most important cause of compromised cardio-pulmonary physiology in acute PE: as right ventricular afterload increases, tension in the right ventricular wall rises, and may lead to dilatation, dysfunction and ischemia of the right ventricle. The right ventricular failure predisposes to hemodynamic instability and cardiogenic shock, two dreadful and often fatal complications of PE requiring thrombolytic treatment even in elderly patients, in an attempt to achieve rapid resolution of the thromboembolus, and to reverse the right ventricular dysfunction underlying this condition [1,2,[6][7][8][9].…”

Predictors and Causes of Long-Term Mortality in Elderly Patients with Acute Venous Thromboembolism: A Prospective Cohort Study

“…2 Despite the higher morbidity and mortality, venous thromboembolism remains understudied in the elderly, 2 and little is known about the predictors and causes of death in older patients with venous thromboembolism. Prior studies reporting predictors and causes of death in elderly patients with venous thromboembolism were limited by a retrospective design, [2][3][4] identified cases with venous thromboembolism using diagnosis codes rather than predefined clinical criteria, 2 failed to report causes of death, 2,5,6 or determined the cause of death without the use of a formal adjudication process. 4,[7][8][9] Moreover, these studies almost exclusively focused on short-term mortality (<6 months), [3][4][5][7][8][9] and predictors and causes of long-term mortality remain largely unknown in the elderly with venous thromboembolism.…”

“…Prior studies reporting predictors and causes of death in elderly patients with venous thromboembolism were limited by a retrospective design, [2][3][4] identified cases with venous thromboembolism using diagnosis codes rather than predefined clinical criteria, 2 failed to report causes of death, 2,5,6 or determined the cause of death without the use of a formal adjudication process. 4,[7][8][9] Moreover, these studies almost exclusively focused on short-term mortality (<6 months), [3][4][5][7][8][9] and predictors and causes of long-term mortality remain largely unknown in the elderly with venous thromboembolism. To fill these gaps of knowledge, we aimed to examine which factors drive long-term mortality and to determine causes of death in a multicenter prospective study of elderly patients with acute venous thromboembolism using a formal mortality adjudication process.…”

Venous Thromboembolism in the Elderly

“…De Bonis et al evaluated elderly patients (>65 years) who had massive PEs and were given thrombolysis. In-hospital mortality was 13.4 %, while 32.7 % patients died during follow-up [95]. They found elevated troponin levels, thrombocytopenia after thrombolysis, and history of cancer and cardiovascular disease to be significant predictors of mortality.…”