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

Study objectives: To determine the risk factors and frequency of intracranial 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 ofthe 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.