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(Circulation. 1998;97:1649-1650.)
© 1998 American Heart Association, Inc.

Correspondence

Association Between Thrombolytic Treatment and the Prognosis of Hemodynamically Stable Patients With Major Pulmonary Embolism

Emile Ferrari, MD; ; Marcel Baudouy, MD

Cardiology Department, Hopital Pasteur, Nice, France

To the Editor:

Konstantinides et al¹ recently reported the results of a major multicenter registry involving more than 700 patients with severe pulmonary embolism (PE) but no clinical instability. They deserve to be congratulated for their interesting data. However, we would like to comment on these data.

We believe that it is particularly difficult to assess PE gravity using only clinical criteria. When patients are prescribed bed rest for a few hours, we have often encountered significant discrepancy between "clinical status" and echocardiography, pulmonary angiography, or right-side catheterization results.² After a few hours' bed rest, patients who have suffered from syncope or transient collapse before hospitalization are often quiet in their beds. Probably the slightest exertion or stress (or the slightest recurrence of PE) would lead to severe clinical signs.

As a result, we believe that in some cases, the lack of hypotension may lead to misdiagnosing the seriousness of PE. In particular, in young patients with no concomitant diseases, blood pressure may be maintained in normal ranges by several compensatory mechanisms. The fact that 70% of the patients reported presented with tachycardia and with a mean oxygen partial pressure of 56 mm Hg strengthens this observation. Consequently, hypotension should not be used as the only clinical criterion to justify thrombolytic treatment. In this regard, we totally agree with the results of Konstantinides et al.

Another important point is the interpretation of the results of this study. As the authors themselves clearly state, "even multivariate analysis cannot be expected to . . . [Full Text of this Article]

Stavros Konstantinides, MD; ; Wolfgang Kasper, MD

Universitaetsklinik Freiberg, Freiberg, Germany