Researcher to doctors: 'Take the chance'
When doctors encounter a patient with a massive pulmonary embolism, they face a difficult choice: Is it wise to administer a drug that could save the patient's life, even though many people suffer life-threatening bleeding as a result?
Based on new findings published in the American Journal of Medicine, Michigan State University researchers are answering that question in no uncertain terms.
"The message to doctors is clear: Take the chance," said Paul D. Stein, a professor in MSU's Department of Osteopathic Medical Specialties. "It doesn't matter how old the patient is or what other chronic diseases the patient has. Administering the drug saves lives."
Pulmonary embolism is a potentially deadly blockage of arteries in the lungs caused by blood clots that travel from elsewhere in the body, usually the leg. Clot-dissolving drugs known as thrombolytic agents often can remove the blockage, but they also can cause brain hemorrhages and other major bleeding.
Stein found in an earlier study that only about a third of unstable pulmonary embolism patients -- those who are in shock or require a ventilator -- received thrombolytic therapy, even though the drugs decreased the risk of dying in the hospital from 50 percent to 15 percent.
"Doctors are smart," Stein said, "so why are only a third of patients getting the drug?"
To find out, Stein and Fadi Matta, MSU associate professor of osteopathic medical specialties, reviewed a national database of records from more than 1,000 hospitals. Their findings suggest that concern over the bleeding associated with thrombolytic therapy may keep doctors from giving the drug to patients who could be at higher risk.