0358: Incidence and predictors of major haemorrhagic complications in pulmonary embolism patients receiving thrombolytic therapy

Thrombolytic therapy (TT) has a beneficial risk to benefit ratio for patients presenting with massive pulmonary embolism (PE). The PEITHO study suggested that patients with sub massive PE may improve their hemodynamic status and prognosis after TT but with an excess of haemorrhagic complications (HC). Elderly patients are also more likely to experience sever HC and it has been suggested that half doses TT may be indicated in this population. TT indication remains questionable in these borderline patients.To investigate incidence and predictors of major HC in our population we performed a retrospective analysis of all PE patients treated with TT in the Cardiac Intensive Care Unit of our university hospital from 1992 to 2014.From February 1992 to December 2014, 293 PE patients received TT. Among them 35 experienced severe HC following the PEITHO study definition. 23 (8%) patients died during the acute phase, 7 from HC and 16 from haemodynamic complications.Although before 1996 TT was frequently administered in sub massive PE and elderly patients we didn’t observed a significantly higher rate of severe HC in the 1992-1996 period. Bleeders were not significantly older than non-bleeders (72 vs 67, p=0,09) and were more likely to receive alteplase as TT (p=0,045). Severe HC were significantly more frequent in patients presenting with syncope (37% vs 15%, p=0,0064) or shock (66% vs 36%, p=0,0006). Patients with severe HC had a significantly higher death rate during hospitalisation (23% vs 6%, p=0,0005). From our observational data we derived the HACASSP score that robustly predicts severe haemorrhagic complications in our population combining hypertension, age>75, cancer, anemia, shock, sex, platelet count (C statistic=0.73).Our analysis suggests that it may be possible to predict high risk of severe haemorrhagic complications of TT in PE patients and therefore to improve the risk to benefit ratio of TT especially in patients with sub massive PE at presentation