scholarly journals Impact of Identification and Treatment of Depression in Heart Transplant Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ike Okwuosa ◽  
Dara Pumphrey ◽  
Jyothy Puthumana ◽  
Rachel-Maria Brown ◽  
William Cotts
Keyword(s):  
Statistical Difference ◽  
Orthotopic Heart Transplantation ◽  
Transplant Patients ◽  
Primary Endpoints ◽  
Treatment Of Depression ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Cardiac Heart Failure ◽  
Attending Physician ◽  
The Impact

Background. The effects of clinical depression after orthotopic heart transplantation (OHT) are relatively unknown. The purpose of this study was to evaluate the impact of depression on outcomes after OHT. Methods. We performed a single center retrospective review of 102 consecutive patients who underwent OHT at Northwestern Memorial Hospital from June 2005 to October 2009. The diagnosis of depression was obtained from attending physician documentation. The primary endpoints were all-cause mortality (ACM), hospitalizations, and rejection. Results. Of 102 OHT patients, 26 (26%) had depression. Depressed patients were similar in age to nondepressed patients (57.6 years versus 56.9, P=0.79). There was no statistical difference in survival between groups at 5 years after OHT (P=0.94). All-cause hospitalizations were higher in depressed versus nondepressed patients (4.3 versus 2.6 hospitalizations P=0.05). There were no significant differences in hospitalizations between the two groups for the following complications: cardiac (heart failure, edema, arrhythmias, and acute rejection) and infections. There was no significant difference in episodes of 2R and 3R rejection. Conclusion. Early identification and treatment of depression in OHT patients result in outcomes similar to nondepressed patients.

scholarly journals Comparison of epidemiology, treatments, and outcomes in pediatric versus adult ependymoma

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Aladine A Elsamadicy ◽  
Andrew B Koo ◽  
Wyatt B David ◽  
Victor Lee ◽  
Cheryl K Zogg ◽  
...  
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Radiation Treatment ◽  
Age Groups ◽  
Anatomical Location ◽  
Seer Database ◽  
Coding System ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Mounting evidence supports the presence of heterogeneity in the presentation of ependymoma patients with respect to location, histopathology, and behavior between pediatric and adult patients. However, the influence of age on treatment outcomes in ependymoma remains obscure. Methods The SEER database years 1975–2016 were queried. Patients with a diagnosis of ependymoma were identified using the International Classification of Diseases for Oncology, Third Edition, coding system. Patients were classified into one of 4 age groups: children (age 0–12 years), adolescents (age 13–21 years), young adults (age 22–45 years), and older adults (age >45 years). The weighed multivariate analysis assessed the impact of age on survival outcomes following surgical treatment. Results There were a total of 6076 patients identified with ependymoma, of which 1111 (18%) were children, 529 (9%) were adolescents, 2039 (34%) were young adults, and 2397 (40%) were older adults. There were statistically significant differences between cohorts with respect to race (P < .001), anatomical location (P < .001), extent of resection (P < .001), radiation use (P < .001), tumor grade (P < .001), histological classification (P < .001), and all-cause mortality (P < .001). There was no significant difference between cohorts with respect to gender (P = .103). On multivariate logistic regression, factors associated with all-cause mortality rates included males (vs females), supratentorial location (vs spinal cord tumors), and radiation treatment (vs no radiation). Conclusions Our study using the SEER database demonstrates the various demographic and treatment risk factors that are associated with increased rates of all-cause mortality between the pediatric and adult populations following a diagnosis of ependymoma.

Association of Hypothyroidism and Mortality in the Elderly Population: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 105 (6) ◽  
pp. 2068-2080 ◽  
Author(s):  
Tou-Yuan Tsai ◽  
Yu-Kang Tu ◽  
Kashif M Munir ◽  
Shu-Man Lin ◽  
Rachel Huai-En Chang ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Elderly Population ◽  
Meta Analysis ◽  
The Elderly ◽  
Current Evidence ◽  
Cochrane Library ◽  
Overt Hypothyroidism ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact

Abstract Context The evidence of whether hypothyroidism increases mortality in the elderly population is currently inconsistent and conflicting. Objective The objective of this meta-analysis is to determine the impact of hypothyroidism on mortality in the elderly population. Data Sources PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched from inception until May 10, 2019. Study Selection Studies evaluating the association between hypothyroidism and all-cause and/or cardiovascular mortality in the elderly population (ages ≥ 60 years) were eligible. Data Extraction Two reviewers independently extracted data and assessed the quality of the studies. Relative risk (RR) was retrieved for synthesis. A random-effects model for meta-analyses was used. Data Synthesis A total of 27 cohort studies with 1 114 638 participants met the inclusion criteria. Overall, patients with hypothyroidism experienced a higher risk of all-cause mortality than those with euthyroidism (pooled RR = 1.26, 95% CI: 1.15-1.37); meanwhile, no significant difference in cardiovascular mortality was found between patients with hypothyroidism and those with euthyroidism (pooled RR = 1.10, 95% CI: 0.84-1.43). Subgroup analyses revealed that overt hypothyroidism (pooled RR = 1.10, 95% CI: 1.01-1.20) rather than subclinical hypothyroidism (pooled RR = 1.14, 95% CI: 0.92-1.41) was associated with increased all-cause mortality. The heterogeneity primarily originated from different study designs (prospective and retrospective) and geographic locations (Europe, North America, Asia, and Oceania). Conclusions Based on the current evidence, hypothyroidism is significantly associated with increased all-cause mortality instead of cardiovascular mortality among the elderly. We observed considerable heterogeneity, so caution is needed when interpreting the results. Further prospective, large-scale, high-quality studies are warranted to confirm these findings.

scholarly journals Re-Evaluating the Protective Effect of Hemodialysis Catheter Locking Solutions in Hemodialysis Patients

2019 ◽  
Vol 8 (3) ◽  
pp. 412 ◽  
Author(s):  
Chang-Hua Chen ◽  
Yu-Min Chen ◽  
Yu Yang ◽  
Yu-Jun Chang ◽  
Li-Jhen Lin ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Treated Group ◽  
Central Venous Catheters ◽  
Exit Site ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact ◽  
Catheter Function

Catheter-related bloodstream infections (CRBSIs) and exit-site infections (ESIs) are common complications associated with the use of central venous catheters for hemodialysis. The aim of this study was to analyze the impact of routine locking solutions on the incidence of CRBSI and ESI, in preserving catheter function, and on the rate of all-cause mortality in patients undergoing hemodialysis. We selected publications (from inception until July 2018) with studies comparing locking solutions for hemodialysis catheters used in patients undergoing hemodialysis. A total of 21 eligible studies were included, with a total of 4832 patients and 318,769 days of catheter use. The incidence of CRBSI and ESI was significantly lower in the treated group (citrate-based regimen) than in the controls (heparin-based regimen). No significant difference in preserving catheter function and all-cause mortality was found between the two groups. Our findings demonstrated that routine locking solutions for hemodialysis catheters effectively reduce the incidence of CRBSIs and ESIs, but our findings failed to show a benefit for preserving catheter function and mortality rates. Therefore, further studies are urgently needed to conclusively evaluate the impact of routine locking solutions on preserving catheter function and improving the rates of all-cause mortality.

DURAL AUGMENTATION

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 890-897 ◽  
Author(s):  
Zachary N. Litvack ◽  
G. Alexander West ◽  
Johnny B. Delashaw ◽  
Kim J. Burchiel ◽  
Valerie C. Anderson
Keyword(s):  
Postoperative Infection ◽  
Patient Characteristics ◽  
Multivariate Regression Analysis ◽  
Collagen Sponge ◽  
Csf Leak ◽  
Neurosurgical Procedures ◽  
Posterior Fossa Surgery ◽  
Primary Endpoints ◽  
Significant Difference ◽  
The Impact

Abstract OBJECTIVE Primary closure of the dura remains difficult in many neurosurgical cases. One option for dural grafting is the collagen sponge, which is available in multiple forms, namely, monolayer collagen and bilayer collagen. Our primary goal was to assess differences in the incidence of postoperative cerebrospinal fluid (CSF) leak, including fistula and pseudomeningocele, and postoperative infection between monolayer collagen and bilayer collagen grafts. METHODS A single-center retrospective analysis of 475 consecutive neurosurgical procedures was performed. Primary endpoints were CSF leak and infection, adjusting for the impact of additional nonautologous materials. Multivariate regression analysis was used to identify predictors of postoperative CSF leak and infection. RESULTS The overall frequency of postoperative CSF leak was 6.7%. There was no significant difference in the incidence of CSF leak based on the type of collagen sponge (monolayer versus bilayer) used (5.5% versus 7.5%, respectively; P = 0.38). The overall frequency of postoperative infection was 4.2%. There was no significant difference in the incidence of infection between groups (4.9% versus 3.8%; P = 0.54). Bilayer sponges were associated with a significantly lower incidence of CSF leak than monolayer sponges (odds ratio, 0.09; 95% confidence interval, 0.01–0.73). CONCLUSION Bilayer collagen sponges are associated with a reduction in postoperative CSF leak, notably in posterior fossa surgery. The need for additional non-native materials is predictive of postoperative CSF leak, along with location and type of procedure. Intrinsic patient characteristics (e.g., age, diabetes, smoking) do not seem to affect the efficacy of collagen sponge dural grafts.

scholarly journals 1461. Impact of the Ampicillin/Sulbactam Shortage on Antibiotic Prescribing and Clinical Outcomes for Adult Inpatients with Aspiration Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S732-S733
Author(s):  
Mary L Staicu ◽  
Ian Murphy ◽  
Maryrose R Laguio-Vila
Keyword(s):  
Clinical Outcomes ◽  
Aspiration Pneumonia ◽  
Total Duration ◽  
Primary Objective ◽  
Hospital Length Of Stay ◽  
Antibiotic Prescribing ◽  
Readmission Rates ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Ampicillin/sulbactam is a recommended first-line agent for the treatment of aspiration pneumonia. Due to the ampicillin/sulbactam shortage, beginning in March 2019, alternative therapies, such as ceftriaxone plus metronidazole, have been utilized more frequently. The objective of this study is to examine clinical outcomes in adult inpatients treated with either ampicillin/sulbactam or ceftriaxone/metronidazole for aspiration pneumonia. Methods An electronic health record report identified patients ≥18 years of age that received ampicillin/sulbactam (pre-March 2019) or ceftriaxone/metronidazole (post-March 2019) with the indication of aspiration pneumonia. The primary objective was to describe 30-day all-cause readmission rates for patients that received ampicillin/sulbactam compared to ceftriaxone/metronidazole. The secondary objectives included hospital length of stay (LOS), 30-day all-cause mortality, C.difficile infection (CDI) within 3 months, and total antibiotic costs. Results A total of 86 patients (50 received ampicillin/sulbactam and 36 received ceftriaxone/ metronidazole) were included. Demographics were similar between groups. There was no significant difference in 30-day all-cause readmission rates (30% vs 19%, p=0.322). The ampicillin/sulbactam group, however, was found to have a significantly higher rate of 30-day all-cause mortality (12% vs 0%, p=0.038). Additionally, total duration of therapy was found to be significantly shorter in the ampicillin/sulbactam group (5 vs 7 days, p=0.002) with reduced overall cost of therapy($130 vs $235, p< 0.001). No differences were observed in hospital LOS or CDI within 3 months. Conclusion No difference was observed in 30-day all-cause readmissions in patients receiving ampicillin/sulbactam compared to ceftriaxone/metronidazole for the treatment of aspiration pneumonia. Further analyses are recommended to evaluate the impact on 30-day all-cause mortality. Disclosures All Authors: No reported disclosures

scholarly journals Sex and age differences in patients with acute coronary syndrome and non-obstructive coronary arteries: presentation and outcome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M G L Williams ◽  
A Dastidar ◽  
K Liang ◽  
T W Johnson ◽  
A Baritussio ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Age Differences ◽  
Coronary Arteries ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact ◽  
Sex And Age Differences

Abstract Aims A substantial number of patients present with acute coronary syndrome (ACS) and non-obstructive coronary arteries. Sex and age differences in these patients are not well understood. This study aims to evaluate the impact of sex and age on clinical presentation and outcome in patients with ACS and non-obstructive coronary arteries, with either an ischaemic or non-ischaemic cause. Methods and results Consecutive patients with an ACS and non-obstructive coronary arteries (n=719) from a single tertiary centre underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Patients with an ischaemic or non-ischaemic aetiology (n=529) on CMR were followed prospectively. All-cause mortality was 11% over a median follow up of 4.9 years, with no significant difference between sexes (11% versus 11% p=0.732). Women were more likely to have an ischaemic aetiology on CMR (40% v 31%, p=0.037). Age group (HR 1.48, p=0.002), log peak troponin (HR 0.78, p=0.033) and LVEF (HR 0.98, p=0.032) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women >60 years (p=0.003). Conclusions There is no difference in all-cause mortality between sexes in patients presenting with ACS and non-obstructive coronary arteries but increasing age is an important predictor of mortality in both sexes. FUNDunding Acknowledgement Type of funding sources: None. Sex differences in CMR diagnosis Sex, age and mortality

scholarly journals 464Optimal timing of invasive coronary angiography following NSTEMI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Mahendiran ◽  
D Nanchen ◽  
D Meier ◽  
B Gencer ◽  
R Klingenberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
Invasive Coronary Angiography ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
Significant Difference ◽  
All Cause Mortality ◽  
One Year ◽  
The Impact ◽  
Grace Score

Abstract Introduction Current guidelines recommend angiography within 24 hours of hospitalisation for patients with non-ST elevation myocardial infarction (NSTEMI). The recent VERDICT study found that angiography within 12 hours of hospitalisation was associated with improved cardiovascular outcomes among high-risk patients. We aimed to obtain a real-world perspective of the impact of angiography timing on one-year outcomes of patients admitted with NSTEMI. Methods Data was obtained from the SPUM-ACS registry, a cohort of consecutive patients hospitalised with acute coronary syndromes in four university hospitals in Switzerland between 2009 and 2017. Patients without a door-to-catheter (DTC) time and those with life-threatening features were excluded. Cox proportional hazards models evaluated the impact of DTC time on the primary endpoint, defined as one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, stroke), and on one-year all-cause mortality. Results Of 2,672 NSTEMI patients, 1,832 met the inclusion criteria. Among them, 1,464 patients underwent angiography within 12 hours of admission (12h group) while 368 patients underwent angiography between 12 and 24 hours (12–24h group). After 2:1 propensity score matching, 736 patients from the 12h group and 368 patients from the 12–24h group were deemed equivalent in terms of main baseline clinical characteristics. Multiple logistic regression identified admission out-of-hours (night or weekend) as the most significant factor associated with delayed angiography. Cox models found no significant association between early angiography and one-year MACE (12h group: n=57 (7.7%) vs. 12–24h group: n=27 (7.3%), HR: 1.050, 95% CI 0.637- 1.733, p=0.847), or one-year all-cause mortality (12h group: n=25 (3.4%) vs. 12–24h group: n=17 (4.6%), HR: 1.514, 95% CI 0.774- 2.962, p=0.225) (Figure 1A). After stratification based on GRACE score (>140 vs. ≤140), there was no significant difference in one-year MACE or one-year all-cause mortality in the 12h group compared with the 12–24h group (p for interaction=0.601 and 0.463, respectively) (Figure 1A + 1B). Figure 1 Conclusion In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of hospitalisation was not associated with improved one-year outcomes when compared with angiography between 12 and 24 hours, even among patients with an elevated GRACE score.

258Use of low-dose prasugrel vs. clopidogrel in elderly patients undergoing complex or non-complex PCI for acute coronary syndromes: insights from the Elderly ACS 2 study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Montalto ◽  
G Crimi ◽  
F Fortuni ◽  
A Mandurino Mirizzi ◽  
L Piatti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Primary Endpoint ◽  
Acute Coronary Syndromes ◽  
Low Dose ◽  
P Value ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
The Impact

Abstract Background Prasugrel was superior to clopidogrel in the setting of acute coronary syndromes (ACS) and recent data highlighted its possible role in the setting of complex percutaneous coronary intervention (PCI). Nonetheless, evidence supporting its use in high bleeding risk population are lacking. Purpose The aim of this post-hoc subgroup analysis was to evaluate the impact of prasugrel administration in elderly patients undergoing complex PCI for ACS. A primary composite endpoint of composite of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year and secondary endpoints of all-cause mortality and any bleeding at 1 year were analyzed. Methods In the multicenter Elderly ACS 2 Study 1,443 patients aged >74 y were randomly assigned to receive low-dose prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year (Table 1). Complex PCI was defined if ≥3 lesions were treated, if ≥3 stents were deployed, or if any bifurcation, trifurcation, chronic total obstruction or moderate-to-severe calcified lesions were treated. Results Patients undergoing complex PCI (n=607) did not experience worse outcome, as compared to those with simpler PCI, in terms of primary endpoint (p=0.21, Figure 1A). Furthermore, in this subgroup, no significant difference was observed with prasugrel vs clopidogrel with regard to the primary endpoint (HR 1.17; CI 0.819–1.67; p=0.39, Figure 1A), all-cause death and bleeding (Figure 1C and 1D). No significant interaction was observed between treatment and PCI complexity (interaction p=0.34). Table 1 Overall Non-complex PCI Complex PCI p value Age (y) 80.60±4.46 80.00 [77.00, 84.00] 80.00 [77.00, 83.00] 0.215 STE-ACS 595 (41.2) 272 (32.5) 323 (53.4) <0.001 Diabetes mellitus 253 (17.5) 159 (19.0) 94 (15.5) 0.104 LVEF 48.27±9.59 49.08±9.55 47.26±9.54 0.002 Total number of diseased vessels 2.29±1.06 2.22±1.06 2.38±1.05 0.005 Previous Myocardial Infarction 274 (19.0) 171 (20.4) 103 (17.0) 0.122 Randomized to prasugrel 713 (49.4) 404 (48.2) 404 (48.2) 0.307 Data are expressed as mean ± SD or [IQR] and count/valid %). Figure 1 Conclusions In elderly patients presenting with ACS low-dose prasugrel was comparable to clopidogrel in terms of all-cause mortality and any bleeding at 1 year. Acknowledgement/Funding None

scholarly journals Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Thakkar ◽  
C Jani ◽  
H P Patel ◽  
S Arora ◽  
R Patel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Atrial Flutter ◽  
Event Analysis ◽  
Preserved Ejection Fraction ◽  
Real World Data ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact

Abstract Background The availability of real-world data regarding the impact of the catheter ablation in patients with concomitant atrial flutter (AFL) and heart failure with preserved ejection fraction (HFpEF) is limited. Methods 2016 and 2017 National Readmission Database (NRD) was subjected to appropriate ICD-10 codes to identify and extract patients having coexistent atrial flutter and heart failure with preserved ejection fraction including who had undergone ablation. At 1 year, all-cause mortality was utilized as the primary outcome while readmissions due to AFL, heart failure (HF) and any other causes were designated as secondary outcomes. Kaplan Meier curves were used for a time to event analysis. Cox proportional hazard regression was used to generate hazard ratios. Results Out of a total 6099 patients with AFL and HFpEF, 906 (14.85%) underwent catheter ablation. At 1 year all cause mortality (3%, vs. 4.4%, HR: 0.661, 95% CI: 0.444–0.985, p=0.042) and readmissions due to AFL (2.3% vs. 5.3%, HR: 0.424, 95% CI: 0.272–0.661, p&lt;0.001) were significantly less among ablation group. Readmission due to HF (9.3% vs. 9.7%, HR: 0.938, 95% CI: 0.745–1.182, p=0.587) and other causes (37% vs.40.3%, HR: 0.926, 95% CI: 0.825–1.040, p=0.193) did not show any significant difference in outcomes at the end of 1 year. Conclusion The utilization of catheter ablation amongst AFL patients with concomitant HFpEF showed a significant reduction in all-cause mortality and readmission due to AFL. However, it did not show any significant changes in readmissions due to HF or other causes at the end of one year. Outcomes of AFL and HFpEF Funding Acknowledgement Type of funding source: None

scholarly journals The Net Clinical Benefit of Thrombolysis in the Management of Submassive Pulmonary Embolism: Systematic Review and Meta-Analysis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2440-2440
Author(s):  
Pedro Alcedo ◽  
Cristhiam Mauricio Rojas Hernandez ◽  
Herney Andres Garcia Perdomo
Keyword(s):  
Overall Survival ◽  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Central Register ◽  
Right Ventricular Strain ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact

Background: Benefit of thrombolytic therapy in patients with massive pulmonary embolism (PE) has been proven. Evidence supporting benefit in clinical outcomes of this approach in the subgroup of patients with submassive PE is lacking. Objective: The primary objective was to determine the impact of thrombolysis on overall survival in patients with submassive PE. Secondary outcomes included bleeding, thrombotic complications, improvement on parameters of right ventricular strain and all cause-mortality. Methods: A search strategy was conducted in MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. Search was also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. We performed a meta-analysis with a fixed effect model according to the heterogeneity. PROSPERO registration number is CRD42019128229. Results: Twelve studies were included in the qualitative and quantitative analysis. 2,564 patients were found among the twelve studies. Risk of bias was assessed mostly as low or unclear risk among the study items. The risk ratio (RR) for all-cause mortality was 1.00 95% CI (0.77 to1.30). The RR of total bleeding and major bleeding were 2.72 95% CI (1.58 to4.69) and 2.17 95% CI (1.03 to4.55), respectively, finding higher risk in thrombolytic therapy. For stroke the RR was 2.22 95% CI (0.17 to28.73), and for recurrent PE the RR was 0.56 95% CI (0.23 to1.37), finding no differences regarding these outcomes. Unfortunately, there were no results reported about overall survival in any of the studies. Conclusion: In patients with submassive PE, the risk of bleeding is higher when thrombolysis is used. There is no significant difference between thrombolysis and anticoagulation in recurrence of PE, stroke, and all-cause mortality Figure Disclosures No relevant conflicts of interest to declare.

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