Thrombolysis for massive pulmonary embolisms in morbid obesity: a multisite case–control study

Abstract

Massive or high-risk pulmonary embolism (PE) confers significant mortality risk and systemic thrombolysis is widely accepted as the first-line treatment in patients without contraindications [1]. High-risk PE in patients with morbid obesity presents unique challenges concerning initial treatments and interventions; in particular, uncertainty over efficacy of weight-based dose adjustments and bleeding complications with antithrombotic therapy [2]. With increasing prevalence of obesity and its independent association with venous thromboembolism (VTE) [3], addressing challenges in management in this patient population has become increasingly relevant. This study evaluated the efficacy and safety of systemic thrombolysis given for massive PE in morbidly obese patients compared to a matched cohort of patients with normal body mass index (BMI). This case–control study assessed efficacy and safety of systematic thrombolysis in morbidly obese patients with massive pulmonary embolisms. Thrombolysis at conventional doses seems to have similar efficacy and bleeding rates in morbidly obese patients. The authors would like to thank Mr Roney Neal from the Vascular Medicine Dept at Princess Alexandra Hospital for maintaining the Venous Thromboembolism Database.