Does thrombolytic therapy reduce mortality in elderly patients with pulmonary embolism?

Background The aim of this study was to investigate mortality in elderly patients diagnosed with massive pulmonary embolism (PE), and to examine the impact of thrombolytic therapy (TT) on mortality. Methods This retrospective cohort study included 109 patients. The clinical, demographic, and laboratory variables of the patients were compared between the survival and mortality groups, between those who received TT and those who did not, and across different age groups. Results The study results showed that the mortality group had a significantly higher mean age (79.4 ± 9.3 vs. 76 ± 7.2, p = 0.04). Key clinical features such as RV SM (p = 0.004) and PESI score (p = 0.03) were significantly different between the groups. Regarding TT, patients who received thrombolysis were younger (p = 0.004) and had a higher EF (p = 0.048). Additionally, RV SM was significantly higher in the TT group (p = 0.04), suggesting better overall RV function in treated patients. Mortality rates were significantly lower in the TT group (p = 0.003). Cox regression analysis identified that receiving TT in patients aged over 75 years was an independent predictor for reduced mortality (HR = 6.05, p = 0.002). Conclusion The findings suggest that TT may play a crucial role in reducing mortality, especially in the population over 75 years of age with massive PE. Age alone should not be a contraindication for TT in elderly patients with massive PE. TT should continue to be a cornerstone of treatment to improve right ventricular function and achieve hemodynamic stabilization.