The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Short-Term Mortality in Patients with Massive and Submassive Pulmonary Embolism Receiving Thrombolytic Therapy

혈전용해 치료를 시행한 광범위 및 아광범위 폐색전증 환자의 단기 사망률

  • Cho, Yun-Ju (Department of Respiratory and Allergy Medicine, Soonchunhyang University College of Medicine) ;
  • Koo, So-My (Department of Respiratory and Allergy Medicine, Soonchunhyang University College of Medicine) ;
  • Bang, Duk Won (Department of Cardiology Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Ki-Up (Department of Respiratory and Allergy Medicine, Soonchunhyang University College of Medicine) ;
  • Uh, Soo-Taek (Department of Respiratory and Allergy Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Yang-Ki (Department of Respiratory and Allergy Medicine, Soonchunhyang University College of Medicine)
  • 조윤주 (순천향대학교 의과대학 호흡기-알레르기내과) ;
  • 구소미 (순천향대학교 의과대학 호흡기-알레르기내과) ;
  • 방덕원 (순천향대학교 의과대학 순환기내과) ;
  • 김기업 (순천향대학교 의과대학 호흡기-알레르기내과) ;
  • 어수택 (순천향대학교 의과대학 호흡기-알레르기내과) ;
  • 김양기 (순천향대학교 의과대학 호흡기-알레르기내과)
  • Published : 2013.01.01
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Abstract

Background/Aims: The mortality rate following massive and submassive pulmonary embolism (PE) remains high despite thrombolytic therapy. Although thrombolytic therapy is considered a life-saving intervention in massive PE, it is only selectively indicated in patients without hypotension who are at high risk of developing hypotension. Little is known about its clinical outcome in Korea. Methods: We retrospectively reviewed the records of patients given thrombolytics for massive and submassive PE objectively confirmed with chest computed tomography at Soon Chun Hyang University Hospital, Seoul, Korea, from 1 January 2004 to 1 August 2011. The primary outcome of this study was 30-day mortality. Secondary outcomes were the incidence of major bleeding at 30 days, mortality at 90 days, and recurrent venous thromboembolism (VTE) at 90 days. Results: Thrombolytic therapy was performed in 21 patients: nine with massive and 12 with submassive PE. The overall 30-day mortality rate was 24% (5/21). The mortality rate in patients with massive PE was higher than that in patients with submassive PE (44% vs. 8%, respectively; p = 0.010). Mortality rates at 90 and 30 days were identical. The estimated causes of death were right ventricular failure in four patients and fatal bleeding in one patient. The median time to death from thrombolysis was 1 day (0-13 days). Major bleeding episodes occurred in three patients (14%), including fatal bleeding in one patient. There was no recurrent VTE at 90 days. Conclusions: Patients who underwent thrombolytic therapy for massive PE showed a higher 30-day mortality compared with patients with submassive PE.

목적: 혈전용해 치료에도 불구하고 광범위 및 아광범위 폐색전증의 사망률은 여전히 높다. 혈전용해치료는 광범위 폐색전증에서 생명을 구할 치료로 여겨지지만 진단 당시 저혈압이 없는 경우 저혈압으로 진행될 수 있는 고위험 환자에서만 선택적으로 적용되고 있다. 국내에서는 이와 관련된 소수의 문헌만이 있는 상태로 이에 혈전용해 치료를 시행한 광범위 및 아광범위 폐색전증 환자들의 단기 사망률에 대해 알아보고자 하였다. 방법: 2004년 1월 1일부터 2011년 7월 30일까지 91개월 동안 순천향대학교 서울병원에서 흉부 컴퓨터촬영을 통해 진단 후 혈전용해제가 투여된 광범위 및 아광범위 폐색전증 환자들을 대상으로 후향적 의무기록 조사를 하였다. 일차 결과는 치료 30일 이내의 사망으로 하였으며 이차 결과는 30일 이내의 주요출혈, 90일 이내의 사망, 90일 이내의 정맥혈전증의 재발로 하였다. 결과: 폐색전증 환자 중 혈전용해제를 투여 받은 환자는 21명으로 광범위 폐색전증 9명, 아광범위 폐색전증 12명이었다. 30일 이내 사망은 5명(24%)으로 광범위 폐색전증 환자 9명 중 4명(44%), 아광범위 폐색전증 환자 12명 중 1명(8%)으로 광범위 폐색전증에서 30일 사망률이 유의하게 높았다(p = 0.010). 혈전용해제 투여 후 30일 사망률과 90일 사망률은 동일하였다. 추정 사망원인은 5명 중 4명(80%)에서 우심실 부전으로 인한 순환기 허탈이었고 1명(20%)은 치명적 출혈로 인한 사망이었다. 혈전용해제 치료부터 사망까지의 시간은 1일(중간값, 0-13일)이었다. 주요출혈은 총 21명 중 3명(14%)에서 발생하였고 이 중 1명 (5%)은 출혈로 인한 사망으로 추정되었다. 90일 이내 정맥혈전증의 재발은 없었다. 결론: 혈전용해치료를 시행받은 환자 중 광범위 폐색전증 환자의 30일 사망률은 아광범위 폐색전증 환자보다 높았다.

Keywords

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