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Chest. 1997 May;111(5):1241-5.

Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors.

Author information

1
Neurology/Neurosurgery Intensive Care Unit, Brigham and Women's Hospital, Boston, MA 02115, USA.

Abstract

STUDY OBJECTIVES:

To determine the risk factors and frequency of intracranial hemorrhage among patients undergoing thrombolysis for pulmonary embolism.

DESIGN:

A retrospective descriptive and controlled analysis.

SETTING:

Hospitalized patients at centers in the United States, Canada, and Italy.

PATIENTS:

All had evidence of pulmonary embolism on perfusion scans or angiography.

INTERVENTIONS:

None.

MEASUREMENTS AND RESULTS:

Data were analyzed on 312 patients from five previously reported studies of pulmonary embolism thrombolysis. The frequency of intracranial hemorrhage up to 14 days after pulmonary embolism thrombolysis was 6 of 312 or 1.9% (95% confidence interval, 0.7 to 4.1%). Two of six intracranial hemorrhages were fatal. Two of the six patients received thrombolysis in violation of the protocol because they had pre-existing, known intracranial disease. Average diastolic BP at the time of hospital 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 and laboratory data were similar in both groups. Decreased level of consciousness, hemiparesis, and visual field deficits were the most common clinical signs of intracranial hemorrhage.

CONCLUSIONS:

Intracranial hemorrhage after pulmonary embolism thrombolysis is an infrequent but often grave complication. Meticulous patient screening before administering thrombolysis is imperative. Diastolic hypertension at the time of hospital admission is a risk factor for intracranial hemorrhage after pulmonary embolism thrombolysis.

PMID:
9149576
DOI:
10.1378/chest.111.5.1241
[Indexed for MEDLINE]

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