thrombolysis with tissue plasminogen activator in patients with acute pulmonary embolisms in the real world: from the command vte registry

There is still uncertainty about the optimal usage of thrombolysis for acute pulmonary embolisms (pes), leading to a widely varying usage in the real world. the command vte registry is a multicenter retrospective registry enrolling consecutive patients with acute symptomatic venous thromboembolisms (vtes) in japan. the present study population consisted of 1549 patients with pes treated with tissue plasminogen activator (t-pa) thrombolysis (n = 180, 12%) or without thrombolysis (n = 1369). thrombolysis with t-pa was implemented in 33% of patients with severe pes, and 9.2% of patients with mild pes with a wide variation across the participating centers. patients with t-pa thrombolysis were younger, and less frequently had active cancer, history of major bleeding, and anemia. at 30 days, t-pa thrombolysis as compared to no thrombolysis was associated with similar mortality rates (5.0% vs. 6.9%, p = 0.33), but a lower adjusted mortality risk (or 0.41; 95% ci 0.18–0.90, p = 0.03), while it was associated with a trend for higher rates of major bleeding (5.6% vs. 2.9%, p = 0.06) and a significantly higher adjusted risk for major bleeding (or 2.39; 95% ci 1.06–5.36, p = 0.03). in patients with severe pes, the mortality rates at 30 days were significantly lower in the t-pa thrombolysis group than no thrombolysis group (15% vs. 37%, p = 0.006). in the present real-world vte registry in japan, t-pa thrombolysis was not infrequently implemented, not only in patients with severe pes, but also in patients with mild pes. a substantial mortality risk reduction might be suggested with t-pa thrombolysis in patients with severe pes.