CLINICAL PRESENTATION AND RESULTS OF THROMBOLYTIC THERAPY IN OLDER PATIENTS WITH MASSIVE PULMONARY-EMBOLISM - A COMPARISON WITH NON-ELDERLYPATIENTS

OBJECTIVE: To assess the clinical presentation and effectiveness of th rombolytic therapy in older patients suffering from massive pulmonary embolism. DESIGN: Analysis of a previously reported study of patients with massive pulmonary embolism using a dichotomous classification of age. SETTING: A medical intensive care unit in one hospital center. PA RTICIPANTS: All subjects had massive pulmonary embolism as evidenced b y scintigraphic and/or angiographic assessment. The 54 patients includ ed in this study were divided into two groups according to age: 28 pat ients were less than 75 years old and 26 patients were 75 years old or older. INTERVENTION: All patients received a bolus regimen of single- chain recombinant tissue-type plasminogen and were subsequently treate d by heparin and warfarin. MEASUREMENTS: Clinical symptoms at admissio n, resolution of scintigraphic vascular obstruction, death rate, hemor rhagic complications, recurrent pulmonary embolism, and long-term foll ow-up were compared between both groups. RESULTS: Clinical symptoms at admission were similar in both groups. The mean absolute improvement in the lung scan perfusion defect, the rate of major bleeding, and the long-term evolution were not statistically different between older an d younger patients. CONCLUSION: Clinical symptoms, including hemodynam ic condition, did not differ between elderly and nonelderly patients s uffering from massive pulmonary embolism. Old age should not preclude thrombolytic therapy in massive pulmonary embolism, provided there is no other contraindication for thrombolytic treatment.