Thrombolysis with tissue plasminogen activator in patients with acute pulmonary embolisms in the real world: from the COMMAND VTE registry.

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  • Additional Information
    • Corporate Authors:
      COMMAND VTE Registry Investigators
    • Source:
      Publisher: Kluwer Academic Publishers Country of Publication: Netherlands NLM ID: 9502018 Publication Model: Print Cited Medium: Internet ISSN: 1573-742X (Electronic) Linking ISSN: 09295305 NLM ISO Abbreviation: J Thromb Thrombolysis Subsets: MEDLINE
    • Publication Information:
      Original Publication: [Dordrecht ; Norwell, MA] : Kluwer Academic Publishers, c1994-
    • Subject Terms:
      Pulmonary Embolism/*drug therapy ; Tissue Plasminogen Activator/*therapeutic use; Acute Disease ; Adult ; Aged ; Hemorrhage/chemically induced ; Humans ; Japan ; Middle Aged ; Pulmonary Embolism/mortality ; Registries ; Retrospective Studies ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/methods ; Thrombolytic Therapy/mortality ; Tissue Plasminogen Activator/adverse effects
    • Abstract:
      There is still uncertainty about the optimal usage of thrombolysis for acute pulmonary embolisms (PEs), leading to a widely varying usage in the real world. The COMMAND VTE Registry is a multicenter retrospective registry enrolling consecutive patients with acute symptomatic venous thromboembolisms (VTEs) in Japan. The present study population consisted of 1549 patients with PEs treated with tissue plasminogen activator (t-PA) thrombolysis (N = 180, 12%) or without thrombolysis (N = 1369). Thrombolysis with t-PA was implemented in 33% of patients with severe PEs, and 9.2% of patients with mild PEs with a wide variation across the participating centers. Patients with t-PA thrombolysis were younger, and less frequently had active cancer, history of major bleeding, and anemia. At 30 days, t-PA thrombolysis as compared to no thrombolysis was associated with similar mortality rates (5.0% vs. 6.9%, P = 0.33), but a lower adjusted mortality risk (OR 0.41; 95% CI 0.18-0.90, P = 0.03), while it was associated with a trend for higher rates of major bleeding (5.6% vs. 2.9%, P = 0.06) and a significantly higher adjusted risk for major bleeding (OR 2.39; 95% CI 1.06-5.36, P = 0.03). In patients with severe PEs, the mortality rates at 30 days were significantly lower in the t-PA thrombolysis group than no thrombolysis group (15% vs. 37%, P = 0.006). In the present real-world VTE registry in Japan, t-PA thrombolysis was not infrequently implemented, not only in patients with severe PEs, but also in patients with mild PEs. A substantial mortality risk reduction might be suggested with t-PA thrombolysis in patients with severe PEs.
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    • Contributed Indexing:
      Keywords: Bleeding; Mortality; Thrombolysis; Tissue plasminogen activator; Venous thromboembolism
    • Accession Number:
      EC 3.4.21.68 (PLAT protein, human)
      EC 3.4.21.68 (Tissue Plasminogen Activator)
    • Publication Date:
      Date Created: 20190707 Date Completed: 20200310 Latest Revision: 20200310
    • Publication Date:
      20221213
    • Accession Number:
      10.1007/s11239-019-01913-x
    • Accession Number:
      31278648