INCREASING AGE IS A MAJOR RISK FACTOR FOR HEMORRHAGIC COMPLICATIONS AFTER PULMONARY-EMBOLISM THROMBOLYSIS

We reviewed our database of 312 patients with pulmonary embolism who r eceived thrombolysis in Five clinical trials. At baseline, none bad a history of stroke, internal bleeding within 6 months, surgery within 1 0 days, or occult blood in stool. Sixty-six major bleeding episodes oc curred within 72 hours of administering thrombolysis in 61 (20%) patie nts: bleeding at the catheterization site (34 cases), gross hematuria (9), intracranial hemorrhage (5), and 18 other bleeding episodes that led to at least a 10% hematocrit decrease. Patients with a major bleed ing complication were on average older than patients with no hemorrhag ic complication (mean age 62.9 +/- 1.9 years vs 56.2 +/- 1.1 years; p = 0.005). In an adjusted analysis, there was a fourfold increased risk of bleeding among patients older than 70 years compared with patients younger than 50 years (relative risk [RR] 3.9; 95% confidence interva l [Cl] 1.7 to 8.9). By using age as a continuous variable, we found a 4% (RR 1.04; 95% CI 1.02 to 1.06) increase in risk of bleeding For eac h incremental year of age. In addition, patients with higher body moss index had an increased risk of bleeding. Patients who had undergone c atheterization had a five times greater risk of bleeding (RR 5.2; 95% CI 1.5 to 17.8). In summary, increasing age, larger body mass index, a nd catheterization predisposed to bleeding complications after pulmona ry embolism thrombolysis.