VPB0646 - Thrombolytic therapy in pulmonary embolism patients with thrombocytopenia: a systematic review

Background: PE remains a common diagnosis in the emergency departments and requires urgent attention. Despite vast research on its management, there are still controversial management guidelines. More specifically, the role of thrombolysis in PE patients with relative contraindications is unclear. There are various reports of patients with PE who had thrombocytopenia and underwent thrombolysis.

Aims: This review aims to pool data from reports of thrombolytic therapy in patients with PE in the context of thrombocytopenia, focusing on the patients' demographics, methods of thrombolysis used, complications, and outcomes of these patients.

Methods: We searched English articles from PubMed, Scopus, and Google Scholar reporting patients with PE, who had thrombocytopenia and underwent thrombolysis. Demographics, clinical characteristics, management, and outcomes of patients were extracted and analyzed in Microsoft Excel 2020 and SPSS version 26 in the form of a systematic review.

Results: We added 11 case reports to this review. The average age of cases presenting with PE and thrombocytopenia who received thrombolysis was 50.5 years, with 54.5% females. Dyspnea (58.3%), Orthopnea (50%), and lower limb pain (25%) were the most commonly reported clinical findings. Most common thrombolysis method was systemic (58.3%) followed by catheter-guided thrombolysis (41.7%). Most common thrombolytic agents used were alteplase (83%) and urokinase (8.3%). Out of 11 articles, one patient who had a segmental PE died due to aspiration pneumonia. Interestingly, no thrombocytopenia-related complications were found. Complications were early infection in one case (8.3%), and aspiration pneumonia in one case (8.3%).

Conclusion(s): Thrombolytic therapy may have a mortality benefit with minimal bleeding risk even in patients with PE in the context of thrombocytopenia. More extensive studies on this specific subset are required to refine the guidelines on the use of thrombolysis in PE.