Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors

Chest. 1997 May;111(5):1241-5. doi: 10.1378/chest.111.5.1241.


Study objectives: To determine the risk factors and frequency of intracranial hemorrhage among patients undergoing thrombolysis for pulmonary embolism.

Design: A retrospective descriptive and controlled analysis.

Setting: Hospitalized patients at centers in the United States, Canada, and Italy.

Patients: All had evidence of pulmonary embolism on perfusion scans or angiography.

Interventions: None.

Measurements and results: Data were analyzed on 312 patients from five previously reported studies of pulmonary embolism thrombolysis. The frequency of intracranial hemorrhage up to 14 days after pulmonary embolism thrombolysis was 6 of 312 or 1.9% (95% confidence interval, 0.7 to 4.1%). Two of six intracranial hemorrhages were fatal. Two of the six patients received thrombolysis in violation of the protocol because they had pre-existing, known intracranial disease. Average diastolic BP at the time of hospital admission was significantly elevated in patients who developed an intracranial hemorrhage (90.3 +/- 15.1 mm Hg) compared with those who did not (77.6 +/- 10.9 mm Hg; p = 0.04). Other baseline characteristics and laboratory data were similar in both groups. Decreased level of consciousness, hemiparesis, and visual field deficits were the most common clinical signs of intracranial hemorrhage.

Conclusions: Intracranial hemorrhage after pulmonary embolism thrombolysis is an infrequent but often grave complication. Meticulous patient screening before administering thrombolysis is imperative. Diastolic hypertension at the time of hospital admission is a risk factor for intracranial hemorrhage after pulmonary embolism thrombolysis.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Comment

MeSH terms

  • Aged
  • Angiography
  • Blood Pressure
  • Cause of Death
  • Cerebral Hemorrhage / chemically induced
  • Cerebral Hemorrhage / etiology*
  • Consciousness
  • Diastole
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Hemiplegia / etiology
  • Humans
  • Hypertension / complications
  • Male
  • Middle Aged
  • Patient Admission
  • Patient Selection
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / drug therapy*
  • Radionuclide Imaging
  • Retrospective Studies
  • Risk Factors
  • Thrombolytic Therapy*
  • Time Factors
  • Vision Disorders / etiology
  • Visual Fields


  • Fibrinolytic Agents