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

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.