THROMBOLYTIC THERAPY FOR PULMONARY-EMBOLISM - FREQUENCY OF INTRACRANIAL HEMORRHAGE AND ASSOCIATED RISK-FACTORS

Study objectives: To determine the risk factors and frequency of intra cranial hemorrhage among patients undergoing thrombolysis for pulmonar y embolism. Design: A retrospective descriptive and controlled analysi s, Setting: Hospitalized patients at centers in the United States, Can ada, and Italy. Patients: All had evidence of pulmonary embolism on pe rfusion scans or angiography. Interventions: None. Measurements and re sults: Data were analyzed on 312 patients from five previously reporte d studies of pulmonary embolism thrombolysis. The frequency of intracr anial hemorrhage up to 14 days after pulmonary embolism thrombolysis w as 6 of 312 or 1.9% (95% confidence interval, 0.7 to 4.1%). Two of six : intracranial hemorrhages were fatal. Two ofthe six patients received thrombolysis in violation of the protocol because they had pre-existi ng, known intracranial disease, Average diastolic BP at the time of ho spital admission was significantly elevated in patients who developed an intracranial hemorrhage (90.3+/-15.1 mm Hg) compared with those who did not (77.6+/-10.9 mm Hg; p=0.04). Other baseline characteristics a nd laboratory data were similar in both groups, Decreased level of con sciousness, hemiparesis, and visual field deficits were the most commo n clinical signs of intracranial hemorrhage. Conclusions: Intracranial hemorrhage after pulmonary embolism thrombolysis is an infrequent but often grave complication, Meticulous patient screening before adminis tering thrombolysis is imperative, Diastolic hypertension at the time of hospital admission is a risk factor for intracranial hemorrhage aft er pulmonary embolism thrombolysis.