Pulmonary embolism in the nursing home population: high frequency at autopsy in female residents

[Comparison of efficacy and tolerability of a thrombolytic treatment with rt-PA in acute massive pulmonary embolism in the elderly and patients under 75 years of age]

BACKGROUND

Pulmonary embolism often occurs in elderly patients. However, clinical presentation and treatment of massive pulmonary embolism (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 referred to our institution with symptoms suggestive of massive PE were included in a therapeutic trial of single-chain rt-PA. Patients with a Miller angiographic score of at least 20/34 were considered for entry into the study. Patients were divided into two groups according to their age. Clinical presentation at admission, resolution of scintigraphic vascular obstruction, death rate, hemorrhagic complications, recurrent pulmonary embolism and long-term follow-up were compared between both groups.

RESULTS

Twenty-eight patients were less than 75 years old and 26 patients were aged 75 years or more. Clinical symptoms at admission were similar in both groups. The mean absolute improvement in the lung scan perfusion defect, the rate of major bleeding, and the long-term evolution were not statistically different between older and younger patients.

CONCLUSION

Clinical presentation and tolerance of massive PE did not differ between elderly and non-elderly patients. Old age should not preclude thrombolytic therapy in massive PE, provided there are no other contraindications for thrombolytic treatment.

Clinical presentation and results of thrombolytic therapy in older patients with massive pulmonary embolism: a comparison with non-elderly patients

OBJECTIVE

To assess the clinical presentation and effectiveness of thrombolytic therapy in older patients suffering from massive pulmonary embolism.

DESIGN

Analysis of a previously reported study of patients with massive pulmonary embolism using a dichotomous classification of age.

SETTING

A medical intensive care unit in one hospital center.

PARTICIPANTS

All subjects had massive pulmonary embolism as evidenced by scintigraphic and/or angiographic assessment. The 54 patients included in this study were divided into two groups according to age: 28 patients were less than 75 years old and 26 patients were 75 years old or older.

INTERVENTION

All patients received a bolus regimen of single-chain recombinant tissue-type plasminogen and were subsequently treated by heparin and warfarin.

MEASUREMENTS

Clinical symptoms at admission, resolution of scintigraphic vascular obstruction, death rate, hemorrhagic complications, recurrent pulmonary embolism, and long-term follow-up were compared between both groups.

RESULTS

Clinical symptoms at admission were similar in both groups. The mean absolute improvement in the lung scan perfusion defect, the rate of major bleeding, and the long-term evolution were not statistically different between older and younger patients.

CONCLUSION

Clinical symptoms, including hemodynamic condition, did not differ between elderly and nonelderly patients suffering from massive pulmonary embolism. Old age should not preclude thrombolytic therapy in massive pulmonary embolism, provided there is no other contraindication for thrombolytic treatment.