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J Thromb Thrombolysis. 2017 Oct;44(3):324-329. doi: 10.1007/s11239-017-1545-6.

Evaluating safety of thrombolysis in chronic kidney disease patients presenting with pulmonary embolism using propensity score matching.

Author information

1
Division of Cardiology, Lehigh Valley Hospital Network, 1250 S Cedar Crest Blvd, Suite 300, Allentown, PA, 18103, USA. b2patel@gmail.com.
2
Division of Cardiology, Lehigh Valley Hospital Network, 1250 S Cedar Crest Blvd, Suite 300, Allentown, PA, 18103, USA.
3
Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
4
Division of Cardiology, Cardiovascular Medicine, Department of Internal Medicine, St Luke's University Health Network, Bethlehem, PA, USA.
5
Division of Nephrology and Cardiology, University of Michigan, Ann Arbor, MI, USA.

Abstract

To assess the safety of thrombolytic therapy in chronic kidney disease (CKD) patients who present with pulmonary embolism (PE). We used the Nationwide Inpatient Sample Database to identify patients who underwent thrombolysis for PE between 2010 and 2014. The patients were divided into two groups: (1) No CKD and (2) CKD. Patients with and without CKD were matched using 1:1 propensity score matching and a caliper width of 0.01. The primary outcomes were in-hospital mortality and hemorrhagic events. The secondary outcomes were blood transfusions, length of stay and total hospitalization charge. Two separate, multivariate analyses were also performed to determine the predictors for primary outcomes. The No CKD group had 16,238 and CKD group had 1341 patients prior to matching. Patients with CKD were older (Median age 67 vs. 57 years; p < 0.01), male (60.6 vs. 51.8%) and had a higher prevalence of coronary artery disease, congestive heart failure, diabetes, hyperlipidemia, hypertension, and prior stroke among other comorbidities. They also had significantly higher rate of in-hospital mortality (OR 1.66) and hemorrhagic events (OR 1.47) prior to matching. Post-matching, there was no difference in hospital mortality (22.9 vs. 21.8%; p = 0.51) or hemorrhagic events (3.8 vs. 3.0%; p = 0.27) between CKD and No CKD groups. Patients with CKD had a longer length of stay, but no difference in proportion of patients receiving a blood transfusion and total hospitalization charges post-matching. Multivariate analysis showed that CKD did not predict mortality (OR 0.88, 0.75-1.02; p = 0.09) or hemorrhagic events (OR 0.89, 95% CI 0.76-1.04; 0.13). There was no increase in rate of hospital mortality or hemorrhagic events among CKD patients who underwent thrombolysis for PE.

KEYWORDS:

Bleeding; Nationwide Inpatient Sample Database; Pulmonary embolism; Thrombolysis

PMID:
28864991
DOI:
10.1007/s11239-017-1545-6
[Indexed for MEDLINE]

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