Thrombolysis safe in elderly patients with pubnonary embolism

Elderly patients with massive pulmonary embolism treated with thrombolytics are not at higher risk for bleeding complications than younger patients, say researchers from Hopital Universitaire Saint-Jacques, Besanr;on, France. This suggests that thrombolysis is a reasonable therapeutic approach for this group of patients.

A group of 89 patients treated with streptokinase or urokinase and heparin was studied prospectively. There were no significant differences in measures of clinical outcome in patients aged ~ 71 years (n = 36; range 71-88 years) compared with younger patients [see graph].

Clin ical course after thrombolytic therapy

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The potential for bleeding complications is the major concern in treating elderly patients with thrombolysis. However, there were no significant differences between the age groups for such complications. In fact, the only predisposing factor for bleeding was the need for early vascular access for pulmonary angiography through the femoral approach or for percutaneous insertion of an intracaval device for partial interruption of the inferior vena cava. This finding led the researchers to modify their management of patients with pulmonary embolism and to advise caution in conducting early invasive procedures.

The possible complications of thrombolytic use in elderly patients with pulmonary embolism have not previously been specifically addressed. Meneveau N. Bassand J.p, Schiele F. Bouras Y. Anguenot T, et al. Safety of thrombolytic therapy in elderly patients with massive pulmonary embolism: a comparison with nonelderly patients_ Journal of the American College of Cardiology 22: 1075· 1079, Oct 1993 IIOO'~"']'"

ISSN 0156-2703/9311113-00151$1 .000 Adl81ntem8t1onal Ltd

THERAPY 15

INPHARMAe 13 Nov 1993