CLINICAL PRESENTATION AND RESULTS OF THRO MBOLYTIS THERAPY IN OLDER PATIENTS WITH MASSIVE PULMONARY-EMBOLISM - A COMPARISON WITH NON-ELDERLY PATIENTS

Background. - Pulmonary embolism often occurs in elderly patients. How ever, clinical presentation and treatment of massive pulmonary embolis m (PE) in the elderly have not been extensively investigated We report the results of rt-PA bolus infusion in patients aged 75 years or more suffering from massive PE. Methods. - Fifty-four adult patients refer ed to our institution with symptoms suggestive of massive PE were incl uded in a therapeutic trial of single-chain rr-PA. Patients with a Mil ler angiographic score of at least 20/34 were considered for entry int o the study. Patients were divided into two groups according to their age. Clinical presentation at admission, resolution of scintigraphic v ascular obstruction, death rate, hemorrhagic complications recurrent p ulmonary embolism and long-term follow-up were compared between both g roups. Results. - Twenty-eight patients were less than 75 years old an d 26 patients were aged 75 years or more. Clinical symptoms al admissi on were similar in both groups. The mean absolute improvement in the l ung scan perfusion defect, the rate of major bleeding, and the long-te rm evolution were nor statistically different between older and younge r patients. Conclusion. - Clinical presentation and tolerance of massi ve PE did not differ between elderly and non-elderly patients. Old age should nor preclude thrombolytic therapy in massive PE, provided ther e are no other contraindications for thrombolytic treatment.