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1 From the Neurology/Neurosurgery Intensive Care Unit, and Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston
2 From the Lund University School of Medicine, Lund, Sweden
3 From the and Harvard Medical School, Boston
4 From the Division of Nuclear Medicine, Beth Israel Hospital, Boston; and Harvard Medical School, Boston
5 From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital; and Harvard Medical School, Boston
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.
Key Words: intracranial hemorrhage • hypertension • pulmonary embolism • thrombolytic therapy
Submitted on August 27, 1996
Accepted on December 5, 2007
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