Thrombolytics and Vena Cava Filters Decrease Mortality in Patients with Unstable Pulmonary Embolism

Standard anticoagulant therapy is very effective in patients with pulmonary embolism who are hemodynamically stable. Hospital mortality is in the range of 5% or less.(1) However, in patients with shock secondary to massive pulmonary embolism, mortality ranges from 30% to 50%.2 A small minority of patients with pulmonary embolism present in shock. In a series of 2392 patients with pulmonary embolism, Kucher et al(3) reported that only 4.5% of 2392 patients with pulmonary embolism had a systolic pressure less than 90 mm Hg and a hospital mortality of 52%.

Three articles in this issue of The American Journal of Medicine by Stein et al(4) and Stein and Matta(5, 6) provide impressive evidence that thrombolytics and vena cava filters, especially when used together, have a dramatic impact on the case fatality of patients with pulmonary embolism who are unstable, defined as in shock or requiring ventilator support. These studies are based on a review of all patients (>2 million) with acute pulmonary embolism who were discharged from 1000 US acute care hospitals over a 10- or 11-year period from 1999 to 2008.

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— James E. Dalen, MD, MPH

This article originally appeared in May 2012 issue of The American Journal of Medicine.

This editorial by Dr. Dalen is related to these three research studies also published in the May 2012 issue of The Journal.

Thrombolytic Therapy in Unstable Patients with Acute Pulmonary Embolism: Saves Lives but Underused

Case Fatality Rate with Pulmonary Embolectomy for Acute Pulmonary Embolism

Impact of Vena Cava Filters on In-hospital Case Fatality Rate from Pulmonary Embolism