NEW YORK (Reuters Health) - Cancer, hemodynamic instability, diabetes, or elevated international normalized ratio (INR) are independent predictors of major hemorrhage following fibrinolytic therapy for acute pulmonary embolism, researchers in Boston report.

Dr. Samuel Z. Goldhaber and colleagues from Harvard Medical School examined the frequency and the predictors of hemorrhage in 104 consecutive patients treated between 1996 and 2004 who received fibrinolytic therapy for pulmonary embolism. The patients, who had a mean age of 51 years, were given continuous intravenous infusion of alteplase 100 mg. The results are published in the January issue of the American Journal of Cardiology.

Overall, 20 patients had major bleeding, and 6 of these patients died in the hospital. The median baseline hematocrit level was lower among patients with major hemorrhage compared with those without a major bleed (34% versus 39%, p = 0.005).

The primary site of bleeding was not known in nine patients. The site was gastrointestinal in six, retroperitoneal in three, intracranial in one, and splenic in one.

The results of multivariate analysis revealed that hemodynamic instability before fibrinolysis (odds ratio 115), cancer (OR 16.0), diabetes (OR 9.6), and elevated INR before fibrinolysis (OR 5.8) independently predicted major hemorrhage.

"A more 'real life assessment' shows a much higher risk of bleeding from pulmonary embolism thrombolysis than most health care providers would have previously suspected," Dr. Goldhaber said in an interview with Reuters Health.

"Thrombolysis should be considered primarily for patients at low bleeding risk," he noted. "Patients at higher risk of bleeding should be considered for catheter or surgical embolectomy and for placement of an inferior vena caval filter."

"We are focusing our efforts on testing anticoagulants that are more effective and safer than warfarin...We are also refining ways to achieve prompt risk stratification and identification of patients at high risk of adverse outcomes with anticoagulation alone," Dr. Goldhaber said.

"These new methods include gated CT scanning that focuses on right ventricular size and function, as well as optimizing our use of cardiac biomarkers," he explained. "We are also testing a novel pulmonary embolism embolectomy catheter."

Am J Cardiol 2006;97:127-129

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters Limited content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters Limited. Reuters Limited shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.