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

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Sefa Tatar, Yunus Emre Yavuz, Merve Divarcı Kolukısa, Ahmet Lütfi Sertdemir, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7234068/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Elderly patient Massive pulmonary embolism Thrombolytic therapy Complications Mortality Figures Figure 1 Background Pulmonary embolism (PE) is an important cause of cardiovascular mortality caused by the occlusion of pulmonary arteries by thromboembolic material, usually resulting from deep vein thrombosis (DVT) [ 1 ]. Despite significant advances in diagnosis and treatment, PE remains a major cause of morbidity and mortality, particularly in vulnerable populations such as elderly patients. In geriatric patients, the prognosis is further worsened due to the effects of physiological aging, comorbid conditions, and delayed or inadequate treatment [ 2 ]. There are specific diagnostic challenges in the geriatric population. The inability of patients to fully express their symptoms and the presentation of atypical symptoms often lead to misdiagnosis or delayed intervention, contributing to an increase in mortality rates [ 3 ]. Massive pulmonary embolism occurs as a result of large thrombi that significantly reduce pulmonary blood flow, leading to right ventricular dysfunction and acute respiratory and circulatory failure [ 4 ]. Mortality rates in these patients are markedly high, and urgent treatment is required. Thrombolytic therapy is used as the primary treatment for dissolving the thrombus in massive PE patients. The rationale behind thrombolysis is to rapidly restore pulmonary circulation, reduce right heart strain, and prevent complications such as hemodynamic collapse and death [ 5 ]. However, the use of thrombolytic therapy in elderly patients remains a significant topic of debate. Although thrombolysis has been shown to improve survival in younger patients with massive PE, its use in elderly patients is still complex due to the high risk of bleeding complications. Elderly patients often have additional comorbidities such as hypertension, chronic kidney disease, or a history of gastrointestinal bleeding, which increases the risk of hemorrhagic events during fibrinolytic treatment [ 6 ]. Furthermore, age-related reductions in physiological reserves, impaired fibrinolytic systems, and diminished platelet functions raise concerns about the safety and efficacy of thrombolytic therapy in elderly patients [ 7 ]. Therefore, before administering thrombolytic therapy in elderly patients with massive PE, careful consideration of the potential risk-benefit balance between survival and serious bleeding complications should be taken into account. Recent studies have attempted to clarify the role of thrombolytic therapy in the geriatric population, but no conclusive results have been obtained. Some studies have suggested that thrombolysis reduces 30-day mortality in elderly patients and improves clinical outcomes, particularly in hemodynamically unstable patients [ 8 ]. However, other studies have proposed that thrombolysis has no clear benefit on survival and that non-thrombolytic treatments, such as anticoagulation, may be sufficient for certain patients [ 9 ]. Moreover, the optimal timing for thrombolytic therapy and patient selection in this population remains an ongoing area of research. In this study, we aim to evaluate the impact of thrombolytic therapy on the 1-month mortality rate in patients aged 65 and older who develop massive pulmonary embolism. Our goal is to provide evidence that can guide clinical decisions regarding thrombolytic therapy in elderly patients with massive PE by analyzing mortality rates and other clinical outcomes. Methods Study design The study was conducted retrospectively between January 2020 and January 2025, with approval obtained from the local ethics committee. A total of 134 patients aged 65 and above, diagnosed with massive pulmonary embolism, were included in the study. The data were retrieved through a review of hospital records. The patients were followed for one month. At the end of one month, patients who had died were placed in the mortality group, while those who survived were placed in the survival group. The causes of death and mortality status were checked using the national health registry system (E-Nabız). Five patients were excluded from the study due to active infections, five due to hematological diseases, six due to incomplete records, three due to concurrent acute coronary syndrome, two due to concurrent acute renal failure, two due to having pacemakers, and two due to endocarditis-related pulmonary embolism. The study continued with a total of 109 patients. The study flowchart is presented in Figure 1. Each participant was given information about the study, and consent for participation in the study was obtained from each participant. Study protocol The patients were categorized based on whether they received thrombolytic treatment and their age group. One group consisted of patients aged 65-74 years, while the other group consisted of patients aged 75 years and older with massive pulmonary embolism. Additionally, patients were grouped according to their one-month mortality status. Patients who received thrombolytic therapy and were still alive at the end of one month were included in the survival group, while those who died were included in the mortality group. Analyzed clinical variables included age, sex, hemodynamic parameters (systolic and diastolic blood pressure, heart rate, oxygen saturation), and laboratory markers (troponin, D-dimer, proBNP, and C-reactive protein). Echocardiographic parameters such as ejection fraction (EF), pulmonary artery pressure (PAP), right ventricular free wall motion (RV SM), and tricuspid annular plane systolic excursion (TAPSE) were also recorded. In addition, the Wells score and Geneva score, developed to support the pre-diagnosis of pulmonary embolism, were calculated for each patient. The Pulmonary Embolism Severity Index (PESI) score, used to predict mortality, survival, and clinical outcomes in all patients diagnosed with pulmonary embolism, was also calculated. Information on diseases affecting the cardiovascular system, such as hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, atrial fibrillation, cerebrovascular disease, and chronic lung disease, was recorded. The definitive diagnosis of pulmonary embolism in all patients was made using pulmonary CT angiography. Patients with segmental or subsegmental embolism, excluding the main pulmonary arteries, were not included in the study, even if they were clinically in cardiogenic shock. Alteplase was administered as thrombolytic therapy. All patients who received thrombolytic therapy were given Alteplase at a dose of 100 mg via slow infusion following the same protocol. Patients' histories of DVT, surgical procedures in the last month, need for erythrocyte suspension following thrombolytic therapy, and bleeding symptoms were recorded. Statistical analysis Data analysis was performed using SPSS software (version 20.0; SPSS Inc., Chicago, IL) and presented as mean ± standard deviation or median (interquartile range [IQR]). The normality of distribution was assessed using the Kolmogorov–Smirnov test. Independent Student t-tests were used to compare differences between two groups, while the Mann–Whitney U test was employed for non-normally distributed variables. Differences in categorical variables were assessed using the Chi-square test. Predictors of mortality were evaluated using Cox proportional hazards regression analysis, and results were presented as hazard ratios (HR) with 95% confidence intervals (CI). Cox regression analysis was conducted to identify predictors of 30-day mortality. A p-value of <0.05 was considered statistically significant for all analyses. The patients were divided into two groups: those aged 65-74 years and those aged 75 years and older. Separate Cox regression analyses were conducted for each group. For the 65-74 age group, thrombolytic therapy and EF were found to be independent variables, while for patients aged 75 years and older, thrombolytic therapy and heart rate were identified as independent variables. Results Clinical, demographic, and laboratory characteristics The clinical, demographic, and laboratory characteristics of the patients were analyzed concerning survival status, thrombolytic therapy administration, and age groups. Survival analysis Patients in the mortality group were significantly older than those in the survival group (79.4 ± 9.3 years vs. 76 ± 7.2 years, p = 0.04). Right ventricular systolic motion (RV SM) was significantly lower in the mortality group (3.4 ± 0.77 vs. 6.9 ± 0.97, p = 0.004), while the Pulmonary Embolism Severity Index (PESI) score was higher (160 ± 48 vs. 140 ± 47, p = 0.03). Cardiogenic shock and mental status alteration were more frequent among non-survivors (25% vs. 6.1%, p = 0.008; 45% vs. 22.6%, p = 0.014, respectively). In the survival group, the proportion of patients who received thrombolytic therapy was significantly higher compared to those who did not (73.5% vs. 45%, p = 0.003). Other clinical parameters, including left ventricular ejection fraction (EF), pulmonary artery systolic pressure (PAPs), systolic and diastolic blood pressure, heart rate, oxygen saturation, troponin, D-dimer, proBNP, CRP levels, Wells score, and Geneva score, did not show statistically significant differences between the groups (p > 0.05) (Table 1). Thrombolytic therapy and patient characteristics Patients who received thrombolytics were younger than those who did not (75 ± 7.9 years vs. 80.7 ± 8.8 years, p = 0.004) and had a higher EF (52.8 ± 14.8% vs. 46.7 ± 16.9%, p = 0.048). RV SM was significantly higher in the thrombolytic group (6.1 ± 0.8 vs. 3.4 ± 0.8, p = 0.04), while troponin levels were lower (5.6 ± 1.7 vs. 19.8 ± 7, p = 0.028). The prevalence of heart failure was lower in this group (20.6% vs. 41.3%, p = 0.019), whereas coronary artery disease (CAD) was more frequent (30.2% vs. 13%, p = 0.03). High-risk PESI scores were less common among thrombolytic recipients (38.1% vs. 63%, p = 0.02). More importantly, survival rates were significantly higher in the thrombolytic group (57.1% vs. 28.3%, p = 0.003). No statistically significant differences were observed between thrombolytic and non-thrombolytic groups regarding PAPs, systolic and diastolic blood pressure, oxygen saturation, D-dimer, CRP, Wells and Geneva scores, cardiogenic shock, tricuspid regurgitation severity, right ventricular strain, prior embolism, bleeding, and mental status alterations (p > 0.05) (Table 2). Age-stratified analysis Among patients older than 75 years, survival was significantly better in those receiving thrombolytics (58.8% vs. 23.5%, p = 0.003). The proportion of patients classified as high-risk by PESI was higher in this group (52.9% vs. 76.5%, p = 0.07). No significant differences were observed in CAD, EF, RV SM, TAPSE, systolic and diastolic blood pressure, oxygen saturation, troponin, Wells and Geneva scores, cardiogenic shock, tricuspid regurgitation, right ventricular dysfunction, prior embolism, or PESI risk classification in this age group (p > 0.05). Among patients aged 65–74 years, EF was significantly higher in the thrombolytic group (55.1 ± 11.8% vs. 45.4 ± 11.3%, p = 0.048). However, no significant differences were found regarding survival, RV SM, TAPSE, systolic and diastolic blood pressure, oxygen saturation, troponin, Wells and Geneva scores, cardiogenic shock, tricuspid regurgitation severity, right ventricular dysfunction, prior embolism, and PESI risk classification (p > 0.05) (Table 3). Predictors of mortality Cox regression analysis identified thrombolytic therapy as a significant independent predictor of reduced mortality in patients older than 75 years (HR: 6.050, 95% CI: 1.910–19.161, p = 0.002). However, in the 65–74 age group, heart rate (p = 0.19), EF (p = 0.36), and thrombolytic therapy (p = 0.66) were not significant predictors (Table 4). Discussion In this retrospective study, we investigated the effect of thrombolytic therapy on one-month mortality in elderly patients diagnosed with massive pulmonary embolism (PE). Our findings suggest that thrombolytic therapy could have a significant impact on survival outcomes, especially in hemodynamically unstable patients. In this patient group, which is fragile due to physiological aging and comorbidities, it is noteworthy that the rates of bleeding complications were similar between those who received thrombolytics and those who did not. This is promising for the treatment of massive pulmonary embolism, a major cardiovascular cause of mortality. Pulmonary embolism is the third most common acute cardiovascular syndrome and the leading preventable cause of death among hospitalized patients. First and foremost, the clinical prognostic value of age stands out. It was observed that the average age was higher in the mortality group, which suggests that advanced age not only increases the burden of chronic diseases but also negatively affects the response to acute treatment. The literature emphasizes that advanced age increases the risk of death in acute cardiovascular conditions like pulmonary embolism and requires special attention in treatment strategies [ 10 ]. Elderly patients have a higher incidence of pulmonary embolism and are more susceptible to complications, which increases overall mortality rates. Massive PE is a severe condition that causes high mortality, particularly in elderly individuals with multiple comorbidities [ 11 ]. Physiological changes associated with aging, such as reduced cardiopulmonary reserve, endothelial dysfunction, and impaired coagulation, contribute to a worse prognosis in elderly PE patients [ 12 ]. Furthermore, delays in diagnosis due to atypical clinical presentations further complicate the management of PE [ 13 ]. Thrombolytic therapy is a key treatment for acute conditions such as ischemic stroke, massive pulmonary embolism, and ST-segment elevation myocardial infarction. However, its use in elderly patients (age 75 and above) remains a subject of debate due to concerns regarding efficacy and safety. A study analyzing patients with acute ischemic stroke aged 80 and above found that while long-term outcomes were worse, the early response to treatment was promising, which clarified the medication’s effectiveness [ 14 ]. Similarly, a Chinese registry study showed that elderly patients treated with alteplase, despite having higher MRS scores, had high ambulation rates at discharge and good functional outcomes in the short term, demonstrating the effectiveness of thrombolytic therapy [ 15 ]. A meta-analysis of 11 randomized clinical trials examining elderly patients with acute ST-elevation myocardial infarction found that mortality rates in patients aged 75 years or older were higher (19.7% vs. 5.5%), along with higher adverse event rates compared to younger patients [ 16 ]. Studies evaluating the efficacy and safety of thrombolytic therapy in patients over 75 years of age with pulmonary embolism are limited. A previous study showed that thrombolytic therapy is effective for massive pulmonary embolism, with an acceptable safety profile, including in elderly patients aged 75 years and above [ 17 ]. In brief, while the safety profile of thrombolytic therapy in elderly patients, particularly in acute conditions, is concerning, it has been shown to improve functional outcomes and reduce mortality in certain situations. Our study fills a gap in the literature with its focus on elderly patients with massive pulmonary embolism. The decision to use thrombolytic therapy in elderly patients should be personalized, considering factors such as age, comorbidities, functional status, and complication risk. Further research is needed to optimize treatment strategies and improve outcomes in this vulnerable population. Clinicians should carefully assess the benefits and risks, especially in frail or comorbid patients, to optimize outcomes in this vulnerable population. Age alone should not be a contraindication for thrombolytic therapy in elderly patients with massive pulmonary embolism. The results obtained regarding the impact of thrombolytic therapy particularly highlight significant differences in patients aged 75 and above. In this age group, the mortality rate was much higher in patients who did not receive treatment, whereas survival significantly improved in those who received thrombolytic therapy. The Cox regression analysis showed that thrombolytic therapy was an independent protective factor in patients over 75, supporting its effectiveness in this patient group. On the other hand, the lack of statistically significant results in the 65–74 age group could reflect differences in treatment response related to age or variations in the clinical conditions of the patients at baseline. Polo et al. showed that the one-month mortality rate in patients aged 65 and above with pulmonary embolism was 14.2%, which increased to 18.9% in patients aged 80 and above, demonstrating that mortality rates increase exponentially with age [ 18 ]. One of the key findings in our study is that the one-month mortality rate in patients receiving thrombolytic therapy was significantly lower compared to those who did not. Despite concerns about bleeding complications, this suggests that thrombolytic therapy remains a viable treatment option for selected elderly patients with massive PE. Numerous studies have indicated that thrombolytic therapy can have positive effects on survival in high-risk PE patients. However, some studies emphasize caution in treatment selection due to the increased risk of bleeding and other complications in elderly patients [ 19 – 21 ]. Our findings suggest that, when appropriate patient selection is made and the clinical condition is carefully evaluated, thrombolytic therapy can reduce mortality in the elderly. However, decisions about treatment must consider the patient’s overall cardiac function, comorbidities, and potential risks of complications. The decision to administer thrombolytics in this age group is challenging due to the increased risk of major bleeding, including intracranial hemorrhage. Previous studies have shown that the risk of hemorrhagic complications is higher in elderly patients, particularly those with hypertension, chronic kidney disease, or a history of gastrointestinal bleeding [ 7 , 22 ]. However, Zengin et al. found that, although patients aged 80 and above with pulmonary embolism who received thrombolytic therapy had lower mortality rates, there was no significant difference in major bleeding rates compared to those who did not receive therapy [ 23 ]. The results of this study are similar to ours, as we also found no significant differences in bleeding complications between patients who received thrombolytic therapy and those who did not. Additionally, we observed that patients aged 75 and above who received thrombolytics had mortality rates six times lower than those who did not. Another significant aspect of our findings is the relationship between improved hemodynamic parameters and thrombolytic therapy. Patients who received thrombolytic therapy had improved TAPSE and lower RV strain, indicating better right ventricular function. As is well known, right ventricular dysfunction is closely associated with poor outcomes in PE [ 24 , 25 ]. Thrombolytic therapy, by providing rapid and early intervention, reduces right ventricular pressure load and positively affects survival. In our study, right ventricular function was better preserved in the survival group, which could be attributed to the rapid resolution of pulmonary circulation and thrombus dissolution through thrombolytic therapy. This finding is consistent with previous studies that reported thrombolytic therapy’s role in achieving hemodynamic stabilization [ 26 , 27 ]. Polo et al. suggested in their study that 46.2% of patients aged 80 and above with pulmonary embolism had long-term survival rates, attributing this more to comorbidities than to pulmonary embolism itself [ 28 ]. In our study, we also observed that patients aged 65 and above who received thrombolytic therapy had lower one-month mortality rates. When dividing patients into two age groups (65–74 and 75 and above), the reduction in mortality was only statistically significant in patients aged 75 and above who received thrombolytics. This can be explained by several factors. First, patients aged 65–74 tend to have better echocardiographic parameters, fewer comorbidities, better clinical scores such as PESI, Geneva, and Wells, and better hemodynamic parameters. Second, the presence of collateral circulation in the arterial system may also contribute to improved outcomes. Hesselmann et al. demonstrated that the number of collateral vessels positively affected the success of mechanical revascularization in patients with acute MCA and ICA occlusion [ 29 ]. Similarly, while the underlying etiological causes of coronary collateral development remain unclear, hypoxia and ischemia are thought to be contributing factors. The presence of coronary collaterals in patients with acute myocardial infarction reduces infarct size, decreases myocardial cell death, and improves survival outcomes. In our study, the differences in mortality between patients aged 65 and 75 could also be explained by this phenomenon. As age increases and comorbid conditions become more prevalent, collateral circulation increases, providing a beneficial effect on mortality in cases of acute obstruction. The retrospective nature of the study and the differences in baseline characteristics among patient groups present certain limitations in interpreting the results. These limitations, particularly the variability in comorbidity profiles, cardiac function parameters, and laboratory values, may restrict the generalizability of the findings. Therefore, prospective and randomized controlled trials are essential to better clarify the efficacy of thrombolytic therapy in elderly patients. Additionally, the differences between age groups, particularly the heterogeneous nature of the 65–74 and 75 + age groups, present challenges in comparing treatment responses and clinical characteristics of the patients. Furthermore, these age-related differences can contribute to varied responses to treatment, which in turn can introduce heterogeneity in the research results. Another key limitation is the sample size of the study. Since the study is limited to patients from a specific region with a relatively small number of participants, there are concerns about the generalizability of the findings. Moreover, the variability in treatment protocols based on clinical decisions and individual patient characteristics further complicates the results. The study’s follow-up period is also a significant limitation. With only a 1-month follow-up, it is insufficient to observe the long-term effects of thrombolytic therapy. This short follow-up period limits the ability to assess the long-term outcomes of treatment, such as mortality, morbidity, and quality of life. The effects of thrombolytic therapy over a more extended period should be studied to provide a comprehensive understanding of its impact on clinical recovery and long-term quality of life. Conclusion In conclusion, the findings suggest that thrombolytic therapy plays a significant role in reducing mortality, particularly in patients over 75 years of age with massive pulmonary embolism. Age alone should not be considered a contraindication for thrombolytic therapy in elderly patients with massive pulmonary embolism. Improving right ventricular function and achieving hemodynamic stabilization are key mechanisms underlying the therapy's effectiveness. In clinical practice, carefully evaluating the risk/benefit balance for this patient group, optimizing treatment strategies, and guiding future research are important considerations. Declarations Data sharing statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Authors contributions Conception: Sefa Tatar; Design: Yunus Emre Yavuz; Supervision: Abdullah Icli, Hakan Akilli, Materials: Ahmet Lutfi Sertdemir; Data Collection and/or Processing: Merve Divarcı Kolukısa; Analysis and/or Interpretation: Sefa Tatar; Literature: Sefa Tatar, Review: Sefa Tatar, Abdullah Icli, Hakan Akilli, Ahmet Lutfi Sertdemir, Yunus Emre Yavuz; Writing: Sefa Tatar; Critical Review: Abdullah Icli, Hakan Akilli, Ahmet Lutfi Sertdemir, Yunus Emre Yavuz. Conflict of interest The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Funding The authors received no financial support for the research and/or authorship of this article. Ethics committee approval This study was carried out in accordance with the Declaration of Helsinki. 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Tables Table 1 Comparison of clinical, demographic and laboratory characteristics of patients according to survival status Variables Mortality Surviving P- value Age, years 79.4±9.3 76±7.2 0.04 EF, % 49.5±15.6 51.1±16.4 0.6 PAPs, mmHg 47±20 43±20 0.3 RV SM 3.4±0.77 6.9±0.97 0.004 TAPSE 0.71±0.28 1.07±0.14 0.2 TAPSE/PAPs ratio 0.12±0.11 0.03±0.01 0.4 Systolic blood pressure, mmHg 111±23 111±20 0.9 Diastolic blood pressure, mmHg 69±16 72±12 0.3 Heart rate, BPM 100±31 101±21 0.8 Oxygen saturation, % 84±9 85±9 0.7 Troponin, ng/L 17±5.5 4.9±1.9 0.055 D-Dimer, mg/L 610±545 156±53 0.4 ProBNP, pg/ml 900±300 191±133 0.4 CRP, mg/L 57±7 75±7 0.1 Wells scores 5.3±2.2 5.5±1.8 0.6 Genova score 6.9±2.9 7.1±2.3 0.6 PESI scores 160±48 140±47 0.03 Age, years --->75 --- <75 40 (66.7) 20 (33.3) 28 (57.1) 21 (42.9) 0.3 Lytic ---Lytic ---Non-lytic 27 (45) 33 (55) 36 (73.5) 13 (26.5) 0.003 Heart failure, n, % 21 (35) 11 (22.4) 0.1 DM, n, % 17 (28.3) 17 (34.7) 0.4 HT, n, % 27 (45) 17 (34.7) 0.2 CAD, n, % 8 (13.3) 17 (34.7) 0.008 CVD, n, % 12 (20) 7 (14.3) 0.4 CKD, n, % 9 (15) 6 (12.2) 0.6 AF, n, % 8 (13.3) 9 (18.4) 0.4 Lung disease, n, % 10 (16.7) 11 (22.4) 0.4 Smoking, n, % 18 (30) 9 (18.4) 0.1 DVT, n, % 10 (16.7) 13 (26.5) 0.2 Vascular disease, n, % 7 (11.7) 9 (18.4) 0.3 Surgery history, n, % 12 (20) 12 (24.5) 0.5 Hemoptysis, n, % 11 (18.3) 8 (16.3) 0.7 Dyspnea, n, % 50 (83.3) 42 (85.7) 0.7 Chest pain, n, % 20 (33.3) 9 (18.4) 0.07 Cardiogenic shock, n, % 15 (25) 3 (6.1) 0.008 Anti-coagulant history, n, % 7 (11.7) 7 (14.3) 0.6 Immobilization, n, % 13 (21.7) 14 (28.6) 0.4 TR, n, % --- Mild --- Moderate --- Severe 51 (85) 5 (8.3) 4 (6.6) 39 (79.5) 6 (12.2) 4 (8.2) 0.2 Suppression right ventricular, n, % 28 (46.7) 16 (32.7) 0.1 History of receiving ES, n, % 12 (20) 10 (20.4) 0.9 Bleeding, n, % 16 (26.7) 9 (18.4) 0.3 Mental change, n, % 27 (45) 11 (22.6) 0.014 EF Ejection fraction, PAPs Pulmonary artery systolic pressure, RV SM Right ventricular systolic motion, TAPSE Tricuspid annular plane systolic excursion, ProBNP Pro-Brain natriuretic peptide, CRP C-reactive protein, PESI Pulmonary embolism severity index, DM Diabetes mellitus, HT Hypertension, CAD Coronary artery disease, CVD Cerebrovascular disease, CKD Chronic kidney disease, AF Atrial fibrillation, DVT Deep vein thrombosis, TR Tricuspid regurgitation, ES Erythrocyte suspension Table 2 Comparison of clinical, demographic and laboratory characteristics of patients according to thrombolytic treatment status Variables Lytic (+) Lytic (-) P- value Age, years 75±7.9 80.7±8.8 0.004 EF, % 52.8±14.8 46.7±16.9 0.048 PAPs, mmHg 43±21 48±19 0.2 RV SM 6.1±0.8 3.4±0.8 0.04 TAPSE 1.1±0.2 0.56±0.12 0.11 TAPSE/PAPs ratio 0.13±0.1 0.01±0.002 0.3 Systolic blood pressure, mmHg 109±21 114±22 0.2 Diastolic blood pressure, mmHg 71±14 69±14 0.5 Heart rate, BPM 105±27 95±26 0.041 Oxygen saturation, % 84±10 85±8 0.6 Troponin, ng/L 5.6±1.7 19.8±7 0.028 D-Dimer, mg/L 690±522 299±88 0.2 CRP, mg/L 66±7 64±8 0.8 Wells scores 5.6±1.8 5.2±2.3 0.3 Genova score 7.1±2.6 6.7±2.8 0.4 PESI scores 147±51 155±46 0.4 Age, years --->75 --- <75 34 (54) 29 (46) 34 (73.9) 12 (26.1) 0.034 Heart failure, n, % 13 (20.6) 19 (41.3) 0.019 DM, n, % 22 (34.9) 12 (26.1) 0.3 HT, n, % 23 (36.5) 21 (45.7) 0.3 CAD, n, % 19 (30.2) 6 (13) 0.03 CVD, n, % 10 (15.9) 9 (19.6) 0.6 DVT, n, % 15 (23.8) 8 (17.4) 0.4 Surgery history, n, % 13 (20.6) 11 (23.9) 0.6 Hemoptysis, n, % 13 (20.6) 6 (13) 0.3 Cardiogenic shock, n, % 11 (17.5) 7 (15.2) 0.7 TR, n, % --- Mild --- Moderate --- Severe 53 (84.1) 7 (11.1) 3 (4.8) 37 (80.5) 4 (8.7) 5 (10.9) 0.4 Suppression right ventricular, n, % 29 (46) 15 (32.6) 0.15 History of receiving ES, n, % 12 (19) 10 (21.7) 0.7 Bleeding, n, % 12 (19) 13 (28.3) 0.2 Mental change, n, % 22 (34.9) 16 (34.8) 0.9 Survival, n, % --Mortality --Surviving 27 (42.9) 36 (57.1) 33 (71.7) 13 (28.3) 0.003 EF Ejection fraction, PAPs Pulmonary artery systolic pressure, RV SM Right ventricular systolic motion, TAPSE Tricuspid annular plane systolic excursion, CRP C-reactive protein, PESI Pulmonary embolism severity index, DM Diabetes mellitus, HT Hypertension, CAD Coronary artery disease, CVD Cerebrovascular disease, DVT Deep vein thrombosis, TR Tricuspid regurgitation, ES Erythrocyte suspension Table 3 Comparison of clinical, demographic and laboratory characteristics of patients according to age variable Variables >75 Lytic (+) >75 Lytic (-) P value 65-74 Lytic (+) 65-74 Lytic (-) P- value Age, years 82±4.8 84.5±6.6 0.07 68.7±3.3 69.8±3.5 0.3 CAD, n, % 10 (29.4) 4 (11.8) 0.07 9 (31) 2 (16.7) 0.3 EF, % 50.8±16.9 47.2±17 0.3 55.1±11.8 45.4±11.3 0.048 PAPs, mmHg 46±25 50±19 0.4 40±14 41±16 0.7 RV SM 6.3±1.2 4±1 0.1 5.9±1.2 2±1.4 0.08 TAPSE 1.2±0.4 0.6±0.1 0.2 0.9±0.1 0.3±0.2 0.07 Systolic blood pressure, mmHg 109±22 113±23 0.4 108±20 116±19 0.2 Diastolic blood pressure, mmHg 72±15 68±12 0.2 71±13 75±18 0.4 Heart rate, BPM 111±29 95±26 0.02 98±23 92±26 0.4 Oxygen saturation, % 82±11 86±8 0.1 87±8 82±9 0.1 Troponin, ng/L 4.7±2.4 22.7±9.1 0.06 6.8±2.3 11.7±7.9 0.4 Wells scores 5.7±1.7 5.2±2.4 0.3 5.4±2 5±1.9 0.5 Genova score 7.4±3 6.7±2.8 0.2 6.8±1.9 7±2.9 0.8 PESI scores 162±56 164±39 0.8 130±39 131±55 0.9 Cardiogenic shock, n, % 6 (17.6) 6 (17.6) 1 5 (17.2) 1 (8.39 0.4 TR, n, % --- Mild --- Moderate --- Severe 29 (85.3) 3 (8.8) 2 (5.9) 27 (79.4) 3 (8.8) 4 (11.7) 0.8 24 (82.8) 4 (13.8) 1 (3.4) 10 (83.3) 1 (8.3) 1 (8.3) 0.1 Suppression right ventricular, n, % 18 (52.9) 12 (35.3) 0.1 11 (37.9) 3 (25) 0.4 History of receiving ES, n, % 7 (20.6) 6 (17.6) 0.7 5 (17.2) 4 (33.3) 0.2 Survival, n, % --Mortality --Surviving 14 (41.2) 20 (58.8) 26 (76.5) 8 (23.5) 0.003 13 (44.8) 16 (55.2) 7 (58.3) 5 (41.7) 0.4 EF Ejection fraction, PAPs Pulmonary artery systolic pressure, RV SM Right ventricular systolic motion, TAPSE Tricuspid annular plane systolic excursion, CRP C-reactive protein, PESI Pulmonary embolism severity index, DM Diabetes mellitus, HT Hypertension, CAD Coronary artery disease, CVD Cerebrovascular disease, DVT Deep vein thrombosis, TR Tricuspid regurgitation, ES Erythrocyte suspension Table 4 Cox regression results for the predictors of mortality Variables HR (95%CI) P- value >75 age Lytic 6,050 (1,910-19,161) 0.002 Heart rate 1.014 (0.993-1.036) 0.19 65-74 age Lytic 1.375 (0.322-5.875) 0.66 EF 0.975 (0.925-1.029) 0.36 Additional Declarations No competing interests reported. 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11:58:03","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":199989,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7234068/v1/a802d9594089fd8a476685f8.html"},{"id":96285539,"identity":"d5a65378-3abc-4a49-8645-2c05dae56b9b","added_by":"auto","created_at":"2025-11-19 11:58:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58677,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flowchart.\u003c/p\u003e","description":"","filename":"figure1600.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7234068/v1/35f34ee52974a392983b7cee.jpg"},{"id":97671639,"identity":"8dc5e424-5683-4fda-bc22-cf70a96af04a","added_by":"auto","created_at":"2025-12-08 09:32:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1615782,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7234068/v1/46efd0da-b081-4336-ae09-c0cad52e845f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does thrombolytic therapy reduce mortality in elderly patients with pulmonary embolism?","fulltext":[{"header":"Background","content":"\u003cp\u003ePulmonary embolism (PE) is an important cause of cardiovascular mortality caused by the occlusion of pulmonary arteries by thromboembolic material, usually resulting from deep vein thrombosis (DVT) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite significant advances in diagnosis and treatment, PE remains a major cause of morbidity and mortality, particularly in vulnerable populations such as elderly patients. In geriatric patients, the prognosis is further worsened due to the effects of physiological aging, comorbid conditions, and delayed or inadequate treatment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are specific diagnostic challenges in the geriatric population. The inability of patients to fully express their symptoms and the presentation of atypical symptoms often lead to misdiagnosis or delayed intervention, contributing to an increase in mortality rates [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMassive pulmonary embolism occurs as a result of large thrombi that significantly reduce pulmonary blood flow, leading to right ventricular dysfunction and acute respiratory and circulatory failure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Mortality rates in these patients are markedly high, and urgent treatment is required. Thrombolytic therapy is used as the primary treatment for dissolving the thrombus in massive PE patients. The rationale behind thrombolysis is to rapidly restore pulmonary circulation, reduce right heart strain, and prevent complications such as hemodynamic collapse and death [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the use of thrombolytic therapy in elderly patients remains a significant topic of debate. Although thrombolysis has been shown to improve survival in younger patients with massive PE, its use in elderly patients is still complex due to the high risk of bleeding complications. Elderly patients often have additional comorbidities such as hypertension, chronic kidney disease, or a history of gastrointestinal bleeding, which increases the risk of hemorrhagic events during fibrinolytic treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, age-related reductions in physiological reserves, impaired fibrinolytic systems, and diminished platelet functions raise concerns about the safety and efficacy of thrombolytic therapy in elderly patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, before administering thrombolytic therapy in elderly patients with massive PE, careful consideration of the potential risk-benefit balance between survival and serious bleeding complications should be taken into account.\u003c/p\u003e\u003cp\u003eRecent studies have attempted to clarify the role of thrombolytic therapy in the geriatric population, but no conclusive results have been obtained. Some studies have suggested that thrombolysis reduces 30-day mortality in elderly patients and improves clinical outcomes, particularly in hemodynamically unstable patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, other studies have proposed that thrombolysis has no clear benefit on survival and that non-thrombolytic treatments, such as anticoagulation, may be sufficient for certain patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, the optimal timing for thrombolytic therapy and patient selection in this population remains an ongoing area of research.\u003c/p\u003e\u003cp\u003eIn this study, we aim to evaluate the impact of thrombolytic therapy on the 1-month mortality rate in patients aged 65 and older who develop massive pulmonary embolism. Our goal is to provide evidence that can guide clinical decisions regarding thrombolytic therapy in elderly patients with massive PE by analyzing mortality rates and other clinical outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted retrospectively between January 2020 and January 2025, with approval obtained from the local ethics committee. A total of 134 patients aged 65 and above, diagnosed with massive pulmonary embolism, were included in the study. The data were retrieved through a review of hospital records. The patients were followed for one month. At the end of one month, patients who had died were placed in the mortality group, while those who survived were placed in the survival group. The causes of death and mortality status were checked using the national health registry system (E-Nabız). Five patients were excluded from the study due to active infections, five due to hematological diseases, six due to incomplete records, three due to concurrent acute coronary syndrome, two due to concurrent acute renal failure, two due to having pacemakers, and two due to endocarditis-related pulmonary embolism. The study continued with a total of 109 patients. The study flowchart is presented in Figure 1.\u0026nbsp;Each participant was given information about the study, and consent for participation in the study was obtained from each participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients were categorized based on whether they received thrombolytic treatment and their age group. One group consisted of patients aged 65-74 years, while the other group consisted of patients aged 75 years and older with massive pulmonary embolism. Additionally, patients were grouped according to their one-month mortality status. Patients who received thrombolytic therapy and were still alive at the end of one month were included in the survival group, while those who died were included in the mortality group. Analyzed clinical variables included age, sex, hemodynamic parameters (systolic and diastolic blood pressure, heart rate, oxygen saturation), and laboratory markers (troponin, D-dimer, proBNP, and C-reactive protein). Echocardiographic parameters such as ejection fraction (EF), pulmonary artery pressure (PAP), right ventricular free wall motion (RV SM), and tricuspid annular plane systolic excursion (TAPSE) were also recorded. In addition, the Wells score and Geneva score, developed to support the pre-diagnosis of pulmonary embolism, were calculated for each patient. The Pulmonary Embolism Severity Index (PESI) score, used to predict mortality, survival, and clinical outcomes in all patients diagnosed with pulmonary embolism, was also calculated. Information on diseases affecting the cardiovascular system, such as hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, atrial fibrillation, cerebrovascular disease, and chronic lung disease, was recorded. The definitive diagnosis of pulmonary embolism in all patients was made using pulmonary CT angiography. Patients with segmental or subsegmental embolism, excluding the main pulmonary arteries, were not included in the study, even if they were clinically in cardiogenic shock. Alteplase was administered as thrombolytic therapy. All patients who received thrombolytic therapy were given Alteplase at a dose of 100 mg via slow infusion following the same protocol. Patients' histories of DVT, surgical procedures in the last month, need for erythrocyte suspension following thrombolytic therapy, and bleeding symptoms were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS software (version 20.0; SPSS Inc., Chicago, IL) and presented as mean ± standard deviation or median (interquartile range [IQR]). The normality of distribution was assessed using the Kolmogorov–Smirnov test. Independent Student t-tests were used to compare differences between two groups, while the Mann–Whitney U test was employed for non-normally distributed variables. Differences in categorical variables were assessed using the Chi-square test.\u003c/p\u003e\n\u003cp\u003ePredictors of mortality were evaluated using Cox proportional hazards regression analysis, and results were presented as hazard ratios (HR) with 95% confidence intervals (CI). Cox regression analysis was conducted to identify predictors of 30-day mortality. A p-value of \u0026lt;0.05 was considered statistically significant for all analyses. The patients were divided into two groups: those aged 65-74 years and those aged 75 years and older. Separate Cox regression analyses were conducted for each group. For the 65-74 age group, thrombolytic therapy and EF were found to be independent variables, while for patients aged 75 years and older, thrombolytic therapy and heart rate were identified as independent variables.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eClinical, demographic, and laboratory characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical, demographic, and laboratory characteristics of the patients were analyzed concerning survival status, thrombolytic therapy administration, and age groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvival analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients in the mortality group were significantly older than those in the survival group (79.4 ± 9.3 years vs. 76 ± 7.2 years, p = 0.04). Right ventricular systolic motion (RV SM) was significantly lower in the mortality group (3.4 ± 0.77 vs. 6.9 ± 0.97, p = 0.004), while the Pulmonary Embolism Severity Index (PESI) score was higher (160 ± 48 vs. 140 ± 47, p = 0.03). Cardiogenic shock and mental status alteration were more frequent among non-survivors (25% vs. 6.1%, p = 0.008; 45% vs. 22.6%, p = 0.014, respectively). In the survival group, the proportion of patients who received thrombolytic therapy was significantly higher compared to those who did not (73.5% vs. 45%, p = 0.003). Other clinical parameters, including left ventricular ejection fraction (EF), pulmonary artery systolic pressure (PAPs), systolic and diastolic blood pressure, heart rate, oxygen saturation, troponin, D-dimer, proBNP, CRP levels, Wells score, and Geneva score, did not show statistically significant differences between the groups (p \u0026gt; 0.05) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThrombolytic therapy and patient characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who received thrombolytics were younger than those who did not (75 ± 7.9 years vs. 80.7 ± 8.8 years, p = 0.004) and had a higher EF (52.8 ± 14.8% vs. 46.7 ± 16.9%, p = 0.048). RV SM was significantly higher in the thrombolytic group (6.1 ± 0.8 vs. 3.4 ± 0.8, p = 0.04), while troponin levels were lower (5.6 ± 1.7 vs. 19.8 ± 7, p = 0.028). The prevalence of heart failure was lower in this group (20.6% vs. 41.3%, p = 0.019), whereas coronary artery disease (CAD) was more frequent (30.2% vs. 13%, p = 0.03). High-risk PESI scores were less common among thrombolytic recipients (38.1% vs. 63%, p = 0.02). More importantly, survival rates were significantly higher in the thrombolytic group (57.1% vs. 28.3%, p = 0.003). No statistically significant differences were observed between thrombolytic and non-thrombolytic groups regarding PAPs, systolic and diastolic blood pressure, oxygen saturation, D-dimer, CRP, Wells and Geneva scores, cardiogenic shock, tricuspid regurgitation severity, right ventricular strain, prior embolism, bleeding, and mental status alterations (p \u0026gt; 0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAge-stratified analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong patients older than 75 years, survival was significantly better in those receiving thrombolytics (58.8% vs. 23.5%, p = 0.003). The proportion of patients classified as high-risk by PESI was higher in this group (52.9% vs. 76.5%, p = 0.07). No significant differences were observed in CAD, EF, RV SM, TAPSE, systolic and diastolic blood pressure, oxygen saturation, troponin, Wells and Geneva scores, cardiogenic shock, tricuspid regurgitation, right ventricular dysfunction, prior embolism, or PESI risk classification in this age group (p \u0026gt; 0.05). Among patients aged 65–74 years, EF was significantly higher in the thrombolytic group (55.1 ± 11.8% vs. 45.4 ± 11.3%, p = 0.048). However, no significant differences were found regarding survival, RV SM, TAPSE, systolic and diastolic blood pressure, oxygen saturation, troponin, Wells and Geneva scores, cardiogenic shock, tricuspid regurgitation severity, right ventricular dysfunction, prior embolism, and PESI risk classification (p \u0026gt; 0.05) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCox regression analysis identified thrombolytic therapy as a significant independent predictor of reduced mortality in patients older than 75 years (HR: 6.050, 95% CI: 1.910–19.161, p = 0.002). However, in the 65–74 age group, heart rate (p = 0.19), EF (p = 0.36), and thrombolytic therapy (p = 0.66) were not significant predictors (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective study, we investigated the effect of thrombolytic therapy on one-month mortality in elderly patients diagnosed with massive pulmonary embolism (PE). Our findings suggest that thrombolytic therapy could have a significant impact on survival outcomes, especially in hemodynamically unstable patients. In this patient group, which is fragile due to physiological aging and comorbidities, it is noteworthy that the rates of bleeding complications were similar between those who received thrombolytics and those who did not. This is promising for the treatment of massive pulmonary embolism, a major cardiovascular cause of mortality.\u003c/p\u003e\u003cp\u003ePulmonary embolism is the third most common acute cardiovascular syndrome and the leading preventable cause of death among hospitalized patients. First and foremost, the clinical prognostic value of age stands out. It was observed that the average age was higher in the mortality group, which suggests that advanced age not only increases the burden of chronic diseases but also negatively affects the response to acute treatment. The literature emphasizes that advanced age increases the risk of death in acute cardiovascular conditions like pulmonary embolism and requires special attention in treatment strategies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Elderly patients have a higher incidence of pulmonary embolism and are more susceptible to complications, which increases overall mortality rates. Massive PE is a severe condition that causes high mortality, particularly in elderly individuals with multiple comorbidities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Physiological changes associated with aging, such as reduced cardiopulmonary reserve, endothelial dysfunction, and impaired coagulation, contribute to a worse prognosis in elderly PE patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, delays in diagnosis due to atypical clinical presentations further complicate the management of PE [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThrombolytic therapy is a key treatment for acute conditions such as ischemic stroke, massive pulmonary embolism, and ST-segment elevation myocardial infarction. However, its use in elderly patients (age 75 and above) remains a subject of debate due to concerns regarding efficacy and safety. A study analyzing patients with acute ischemic stroke aged 80 and above found that while long-term outcomes were worse, the early response to treatment was promising, which clarified the medication\u0026rsquo;s effectiveness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, a Chinese registry study showed that elderly patients treated with alteplase, despite having higher MRS scores, had high ambulation rates at discharge and good functional outcomes in the short term, demonstrating the effectiveness of thrombolytic therapy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A meta-analysis of 11 randomized clinical trials examining elderly patients with acute ST-elevation myocardial infarction found that mortality rates in patients aged 75 years or older were higher (19.7% vs. 5.5%), along with higher adverse event rates compared to younger patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies evaluating the efficacy and safety of thrombolytic therapy in patients over 75 years of age with pulmonary embolism are limited. A previous study showed that thrombolytic therapy is effective for massive pulmonary embolism, with an acceptable safety profile, including in elderly patients aged 75 years and above [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In brief, while the safety profile of thrombolytic therapy in elderly patients, particularly in acute conditions, is concerning, it has been shown to improve functional outcomes and reduce mortality in certain situations. Our study fills a gap in the literature with its focus on elderly patients with massive pulmonary embolism. The decision to use thrombolytic therapy in elderly patients should be personalized, considering factors such as age, comorbidities, functional status, and complication risk. Further research is needed to optimize treatment strategies and improve outcomes in this vulnerable population. Clinicians should carefully assess the benefits and risks, especially in frail or comorbid patients, to optimize outcomes in this vulnerable population. Age alone should not be a contraindication for thrombolytic therapy in elderly patients with massive pulmonary embolism.\u003c/p\u003e\u003cp\u003eThe results obtained regarding the impact of thrombolytic therapy particularly highlight significant differences in patients aged 75 and above. In this age group, the mortality rate was much higher in patients who did not receive treatment, whereas survival significantly improved in those who received thrombolytic therapy. The Cox regression analysis showed that thrombolytic therapy was an independent protective factor in patients over 75, supporting its effectiveness in this patient group. On the other hand, the lack of statistically significant results in the 65\u0026ndash;74 age group could reflect differences in treatment response related to age or variations in the clinical conditions of the patients at baseline. Polo et al. showed that the one-month mortality rate in patients aged 65 and above with pulmonary embolism was 14.2%, which increased to 18.9% in patients aged 80 and above, demonstrating that mortality rates increase exponentially with age [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. One of the key findings in our study is that the one-month mortality rate in patients receiving thrombolytic therapy was significantly lower compared to those who did not. Despite concerns about bleeding complications, this suggests that thrombolytic therapy remains a viable treatment option for selected elderly patients with massive PE. Numerous studies have indicated that thrombolytic therapy can have positive effects on survival in high-risk PE patients. However, some studies emphasize caution in treatment selection due to the increased risk of bleeding and other complications in elderly patients [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our findings suggest that, when appropriate patient selection is made and the clinical condition is carefully evaluated, thrombolytic therapy can reduce mortality in the elderly. However, decisions about treatment must consider the patient\u0026rsquo;s overall cardiac function, comorbidities, and potential risks of complications. The decision to administer thrombolytics in this age group is challenging due to the increased risk of major bleeding, including intracranial hemorrhage. Previous studies have shown that the risk of hemorrhagic complications is higher in elderly patients, particularly those with hypertension, chronic kidney disease, or a history of gastrointestinal bleeding [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, Zengin et al. found that, although patients aged 80 and above with pulmonary embolism who received thrombolytic therapy had lower mortality rates, there was no significant difference in major bleeding rates compared to those who did not receive therapy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The results of this study are similar to ours, as we also found no significant differences in bleeding complications between patients who received thrombolytic therapy and those who did not. Additionally, we observed that patients aged 75 and above who received thrombolytics had mortality rates six times lower than those who did not.\u003c/p\u003e\u003cp\u003eAnother significant aspect of our findings is the relationship between improved hemodynamic parameters and thrombolytic therapy. Patients who received thrombolytic therapy had improved TAPSE and lower RV strain, indicating better right ventricular function. As is well known, right ventricular dysfunction is closely associated with poor outcomes in PE [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Thrombolytic therapy, by providing rapid and early intervention, reduces right ventricular pressure load and positively affects survival. In our study, right ventricular function was better preserved in the survival group, which could be attributed to the rapid resolution of pulmonary circulation and thrombus dissolution through thrombolytic therapy. This finding is consistent with previous studies that reported thrombolytic therapy\u0026rsquo;s role in achieving hemodynamic stabilization [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePolo et al. suggested in their study that 46.2% of patients aged 80 and above with pulmonary embolism had long-term survival rates, attributing this more to comorbidities than to pulmonary embolism itself [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In our study, we also observed that patients aged 65 and above who received thrombolytic therapy had lower one-month mortality rates. When dividing patients into two age groups (65\u0026ndash;74 and 75 and above), the reduction in mortality was only statistically significant in patients aged 75 and above who received thrombolytics. This can be explained by several factors. First, patients aged 65\u0026ndash;74 tend to have better echocardiographic parameters, fewer comorbidities, better clinical scores such as PESI, Geneva, and Wells, and better hemodynamic parameters. Second, the presence of collateral circulation in the arterial system may also contribute to improved outcomes. Hesselmann et al. demonstrated that the number of collateral vessels positively affected the success of mechanical revascularization in patients with acute MCA and ICA occlusion [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Similarly, while the underlying etiological causes of coronary collateral development remain unclear, hypoxia and ischemia are thought to be contributing factors. The presence of coronary collaterals in patients with acute myocardial infarction reduces infarct size, decreases myocardial cell death, and improves survival outcomes. In our study, the differences in mortality between patients aged 65 and 75 could also be explained by this phenomenon. As age increases and comorbid conditions become more prevalent, collateral circulation increases, providing a beneficial effect on mortality in cases of acute obstruction.\u003c/p\u003e\u003cp\u003eThe retrospective nature of the study and the differences in baseline characteristics among patient groups present certain limitations in interpreting the results. These limitations, particularly the variability in comorbidity profiles, cardiac function parameters, and laboratory values, may restrict the generalizability of the findings. Therefore, prospective and randomized controlled trials are essential to better clarify the efficacy of thrombolytic therapy in elderly patients. Additionally, the differences between age groups, particularly the heterogeneous nature of the 65\u0026ndash;74 and 75\u0026thinsp;+\u0026thinsp;age groups, present challenges in comparing treatment responses and clinical characteristics of the patients. Furthermore, these age-related differences can contribute to varied responses to treatment, which in turn can introduce heterogeneity in the research results. Another key limitation is the sample size of the study. Since the study is limited to patients from a specific region with a relatively small number of participants, there are concerns about the generalizability of the findings. Moreover, the variability in treatment protocols based on clinical decisions and individual patient characteristics further complicates the results. The study\u0026rsquo;s follow-up period is also a significant limitation. With only a 1-month follow-up, it is insufficient to observe the long-term effects of thrombolytic therapy. This short follow-up period limits the ability to assess the long-term outcomes of treatment, such as mortality, morbidity, and quality of life. The effects of thrombolytic therapy over a more extended period should be studied to provide a comprehensive understanding of its impact on clinical recovery and long-term quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the findings suggest that thrombolytic therapy plays a significant role in reducing mortality, particularly in patients over 75 years of age with massive pulmonary embolism. Age alone should not be considered a contraindication for thrombolytic therapy in elderly patients with massive pulmonary embolism. Improving right ventricular function and achieving hemodynamic stabilization are key mechanisms underlying the therapy's effectiveness. In clinical practice, carefully evaluating the risk/benefit balance for this patient group, optimizing treatment strategies, and guiding future research are important considerations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData sharing statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception: Sefa Tatar; Design: Yunus Emre Yavuz; Supervision: Abdullah Icli, Hakan Akilli, Materials: Ahmet Lutfi Sertdemir; Data Collection and/or Processing: Merve Divarcı Kolukısa; Analysis and/or Interpretation: Sefa Tatar; Literature: Sefa Tatar, Review: Sefa Tatar, Abdullah Icli, Hakan Akilli, Ahmet Lutfi Sertdemir, Yunus Emre Yavuz; Writing: Sefa Tatar; Critical Review: Abdullah Icli, Hakan Akilli, Ahmet Lutfi Sertdemir, Yunus Emre Yavuz.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflicts of interest with respect to the authorship and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research and/or authorship of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics committee approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Necmettin Erbakan University (approval no: 2025/5528).\u0026nbsp;During the study, patients were given verbal information about the study and informed written consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTen Cate V, Prochaska JH, Schulz A, Nagler M, Robles AP, Jurk K, et al. Clinical profile and outcome of isolated pulmonary embolism: a systematic review and meta-analysis. EClinicalMedicine. 2023; 59.\u003c/li\u003e\n\u003cli\u003eBikdeli B, Piazza G, Jimenez D, Muriel A, Wang Y, Khairani CD, et al. Sex differences in presentation, risk factors, drug and interventional therapies, and outcomes of elderly patients with pulmonary embolism: rationale and design of the SERIOUS-PE study. 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Effectiveness and safety of thrombolytic therapy in elderly patients with pulmonary embolism. J Thromb Thrombolysis. 2015; 40(4): 424\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003ePolo Friz HP, Molteni M, Del Sorbo D, Pasciuti L, Crippa M, Villa G, et al. Mortality at 30 and 90 days in elderly patients with pulmonary embolism: A retrospective cohort study. Intern Emerg Med. 2015; 10(6): 431-6. \u003c/li\u003e\n\u003cli\u003eKonstantinides SV, Vicaut E, Danays T, Becattini C, Bertoletti LB, Westendorf JB, et al. Impact of thrombolytic therapy on the long-term outcome of intermediate-risk pulmonary embolism. J Am Coll Cardiol. 2017; 69(12): 1536\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zdemir L, \u0026Ouml;zdemir B, \u0026Ccedil;alışkan SN, Ersoy A, Durkaya S. Trombolitik tedavinin nadir \u0026ouml;l\u0026uuml;mc\u0026uuml;l bir komplikasyonu: Kranyal kanama. İzmir G\u0026ouml;ğ\u0026uuml;s Hastanesi Dergisi. 2015; 29(3): 165-8.\u003c/li\u003e\n\u003cli\u003eKandemir Ş, Tatar S, İ\u0026ccedil;li A, Sertdemir A, Akıllı H. Two-edged knife: Massive pulmonary embolism and thrombolytic contraindication. J Emerg Med Case Rep. 2020; 11(4): 104-7.\u003c/li\u003e\n\u003cli\u003eEberle H, Lyn R, Knight T, Hodge E, Daley M. Clinical update on thrombolytic use in pulmonary embolism: a focus on intermediate-risk patients. Am J Health Syst Pharm. 2018; 75: 1275\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eZengin A, Karataş MB, \u0026Ccedil;anga Y, G\u0026uuml;zelbur\u0026ccedil; \u0026Ouml;, Yelge\u0026ccedil; NS, Emre A. Thrombolytic therapy in octogenarians with acute pulmonary embolism. Arq Bras Cardiol. 2022; 118: 68-74.\u003c/li\u003e\n\u003cli\u003eAmmari Z, Al-Sarie M, Ea A, Sangera R, George JC, Varghese V, et al. Predictors of reduced cardiac index in patients with acute submassive pulmonary embolism. Catheter Cardiovasc Interv. 2021; 97(2): 292-8. \u003c/li\u003e\n\u003cli\u003eBowers T, Goldstein JA. Hemodynamic compromise in pulmonary embolism: \u0026ldquo;A tale of two ventricles.\u0026rdquo; Catheter Cardiovasc Interv. 2021; 97(2): 299-300. \u003c/li\u003e\n\u003cli\u003eLi HY, Wang YB, Ren XY, Wang J, Wang HS, Jin YH. Comparative efficacy and safety of thrombolytic agents for pulmonary embolism: A Bayesian network meta-analysis. Pharmacol. 2023; 108(2): 111-26.\u003c/li\u003e\n\u003cli\u003eSu Y, Zou D, Liu Y, Wen C, Zhang X. Anticoagulant impact on clinical outcomes of pulmonary embolism compared with thrombolytic therapy: Meta-analysis. Clin Cardiol. 2024; 47(9): e70016.\u003c/li\u003e\n\u003cli\u003ePolo Friz HP, Orenti A, Brambilla M, Caleffi A, Pezzetti V, Cavalieri d\u0026rsquo;Oro L, et al. Short and long-term mortality in elderly patients with suspected not confirmed pulmonary embolism. Eur J Intern Med. 2020; 73: 36-42. \u003c/li\u003e\n\u003cli\u003eHesselmann V, Niederstadt T, Dziewas R, Ritter M, Kemmling A, Maintz D, et al. Reperfusion by combined thrombolysis and mechanical thrombectomy in acute stroke: effect of collateralization, mismatch, and time to and grade of recanalization on clinical and tissue outcome. Am J Neuroradiol. 2012; 33(2): 336-42.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eComparison of clinical, demographic and laboratory characteristics of patients according to survival status\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurviving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e79.4\u0026plusmn;9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e76\u0026plusmn;7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEF, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e49.5\u0026plusmn;15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e51.1\u0026plusmn;16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPs, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e47\u0026plusmn;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e43\u0026plusmn;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRV SM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e3.4\u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6.9\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.71\u0026plusmn;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.07\u0026plusmn;0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPSE/PAPs ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.12\u0026plusmn;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.03\u0026plusmn;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystolic blood pressure, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e111\u0026plusmn;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e111\u0026plusmn;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiastolic blood pressure, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e69\u0026plusmn;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e72\u0026plusmn;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart rate, BPM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e100\u0026plusmn;31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e101\u0026plusmn;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen saturation, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e84\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e85\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTroponin, ng/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e17\u0026plusmn;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e4.9\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD-Dimer, mg/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e610\u0026plusmn;545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e156\u0026plusmn;53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProBNP, pg/ml\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e900\u0026plusmn;300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e191\u0026plusmn;133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP, mg/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e57\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e75\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWells scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.3\u0026plusmn;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.5\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenova score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6.9\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7.1\u0026plusmn;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePESI scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e160\u0026plusmn;48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e140\u0026plusmn;47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e---\u0026gt;75\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- \u0026lt;75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (66.7)\u003c/p\u003e\n \u003cp\u003e20 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (57.1)\u003c/p\u003e\n \u003cp\u003e21 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLytic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e---Lytic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e---Non-lytic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (45)\u003c/p\u003e\n \u003cp\u003e33 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36 (73.5)\u003c/p\u003e\n \u003cp\u003e13 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart failure, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e21 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e11 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e17 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e17 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHT, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e27 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e17 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAD, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e8 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e17 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVD, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCKD, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAF, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e8 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLung disease, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e10 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e11 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e18 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e10 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e13 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular disease, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery history, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoptysis, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e11 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e8 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyspnea, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e50 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e42 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChest pain, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e20 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiogenic shock, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e15 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e3 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti-coagulant history, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmobilization, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e13 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e14 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTR, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Mild\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Moderate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51 (85)\u003c/p\u003e\n \u003cp\u003e5 (8.3)\u003c/p\u003e\n \u003cp\u003e4 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (79.5)\u003c/p\u003e\n \u003cp\u003e6 (12.2)\u003c/p\u003e\n \u003cp\u003e4 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuppression right ventricular, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e28 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e16 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of receiving ES, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e10 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e16 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental change, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e27 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e11 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eEF\u003c/em\u003e Ejection fraction, \u003cem\u003ePAPs\u0026nbsp;\u003c/em\u003ePulmonary artery systolic pressure, \u003cem\u003eRV SM\u003c/em\u003e Right ventricular systolic motion, \u003cem\u003eTAPSE\u003c/em\u003e Tricuspid annular plane systolic excursion, \u003cem\u003eProBNP\u003c/em\u003e Pro-Brain natriuretic peptide, \u003cem\u003eCRP\u003c/em\u003e C-reactive protein, \u003cem\u003ePESI\u0026nbsp;\u003c/em\u003ePulmonary embolism severity index, \u003cem\u003eDM\u0026nbsp;\u003c/em\u003eDiabetes mellitus, \u003cem\u003eHT\u0026nbsp;\u003c/em\u003eHypertension, \u003cem\u003eCAD\u003c/em\u003e Coronary artery disease, \u003cem\u003eCVD\u003c/em\u003e Cerebrovascular disease, \u003cem\u003eCKD\u003c/em\u003e Chronic kidney disease, \u003cem\u003eAF\u0026nbsp;\u003c/em\u003eAtrial fibrillation, \u003cem\u003eDVT\u003c/em\u003e Deep vein thrombosis, \u003cem\u003eTR\u0026nbsp;\u003c/em\u003eTricuspid regurgitation, \u003cem\u003eES\u003c/em\u003e Erythrocyte suspension\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eComparison of clinical, demographic and laboratory characteristics of patients according to thrombolytic treatment status\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLytic (+)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLytic (-)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e75\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e80.7\u0026plusmn;8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEF, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e52.8\u0026plusmn;14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e46.7\u0026plusmn;16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPs, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e43\u0026plusmn;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e48\u0026plusmn;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRV SM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6.1\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e3.4\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.56\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPSE/PAPs ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.13\u0026plusmn;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.01\u0026plusmn;0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystolic blood pressure, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e109\u0026plusmn;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e114\u0026plusmn;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiastolic blood pressure, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e71\u0026plusmn;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e69\u0026plusmn;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart rate, BPM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e105\u0026plusmn;27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e95\u0026plusmn;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen saturation, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e84\u0026plusmn;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e85\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTroponin, ng/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.6\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e19.8\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD-Dimer, mg/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e690\u0026plusmn;522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e299\u0026plusmn;88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRP, mg/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e66\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e64\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWells scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.6\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e5.2\u0026plusmn;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenova score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7.1\u0026plusmn;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6.7\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePESI scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e147\u0026plusmn;51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e155\u0026plusmn;46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e---\u0026gt;75\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- \u0026lt;75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (54)\u003c/p\u003e\n \u003cp\u003e29 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (73.9)\u003c/p\u003e\n \u003cp\u003e12 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart failure, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e13 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e19 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e22 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHT, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e23 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e21 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAD, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e19 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVD, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e10 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e15 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e8 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery history, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e13 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e11 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoptysis, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e13 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e6 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiogenic shock, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e11 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e7 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTR, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Mild\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Moderate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53 (84.1)\u003c/p\u003e\n \u003cp\u003e7 (11.1)\u003c/p\u003e\n \u003cp\u003e3 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (80.5)\u003c/p\u003e\n \u003cp\u003e4 (8.7)\u003c/p\u003e\n \u003cp\u003e5 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuppression right ventricular, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e29 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e15 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of receiving ES, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e10 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e13 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental change, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e22 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e16 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvival, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--Mortality\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--Surviving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (42.9)\u003c/p\u003e\n \u003cp\u003e36 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (71.7)\u003c/p\u003e\n \u003cp\u003e13 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eEF\u003c/em\u003e Ejection fraction, \u003cem\u003ePAPs\u0026nbsp;\u003c/em\u003ePulmonary artery systolic pressure, \u003cem\u003eRV SM\u003c/em\u003e Right ventricular systolic motion, \u003cem\u003eTAPSE\u003c/em\u003e Tricuspid annular plane systolic excursion, \u003cem\u003eCRP\u003c/em\u003e C-reactive protein, \u003cem\u003ePESI\u0026nbsp;\u003c/em\u003ePulmonary embolism severity index, \u003cem\u003eDM\u0026nbsp;\u003c/em\u003eDiabetes mellitus, \u003cem\u003eHT\u0026nbsp;\u003c/em\u003eHypertension, \u003cem\u003eCAD\u003c/em\u003e Coronary artery disease, \u003cem\u003eCVD\u003c/em\u003e Cerebrovascular disease, \u003cem\u003eDVT\u003c/em\u003e Deep vein thrombosis, \u003cem\u003eTR\u0026nbsp;\u003c/em\u003eTricuspid regurgitation, \u003cem\u003eES\u003c/em\u003e Erythrocyte suspension\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eComparison of clinical, demographic and laboratory characteristics of patients according to age variable\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;75\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLytic (+)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;75\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLytic (-)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65-74\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLytic (+)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65-74\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLytic (-)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e82\u0026plusmn;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e84.5\u0026plusmn;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e68.7\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e69.8\u0026plusmn;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAD, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e10 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e9 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEF, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e50.8\u0026plusmn;16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e47.2\u0026plusmn;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e55.1\u0026plusmn;11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e45.4\u0026plusmn;11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPs, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e46\u0026plusmn;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e50\u0026plusmn;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e40\u0026plusmn;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e41\u0026plusmn;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRV SM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6.3\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4\u0026plusmn;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5.9\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1.2\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.6\u0026plusmn;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.9\u0026plusmn;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.3\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystolic blood pressure, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e109\u0026plusmn;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e113\u0026plusmn;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e108\u0026plusmn;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e116\u0026plusmn;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiastolic blood pressure, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e72\u0026plusmn;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e68\u0026plusmn;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e71\u0026plusmn;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e75\u0026plusmn;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart rate, BPM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e111\u0026plusmn;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e95\u0026plusmn;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e98\u0026plusmn;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e92\u0026plusmn;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOxygen saturation, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e82\u0026plusmn;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e86\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e87\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e82\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTroponin, ng/L\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4.7\u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e22.7\u0026plusmn;9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6.8\u0026plusmn;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e11.7\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWells scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5.7\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e5.2\u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5.4\u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenova score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e7.4\u0026plusmn;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e6.7\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6.8\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e7\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePESI scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e162\u0026plusmn;56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e164\u0026plusmn;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e130\u0026plusmn;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e131\u0026plusmn;55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiogenic shock, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e6 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1 (8.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTR, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Mild\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Moderate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--- Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (85.3)\u003c/p\u003e\n \u003cp\u003e3 (8.8)\u003c/p\u003e\n \u003cp\u003e2 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (79.4)\u003c/p\u003e\n \u003cp\u003e3 (8.8)\u003c/p\u003e\n \u003cp\u003e4 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24 (82.8)\u003c/p\u003e\n \u003cp\u003e4 (13.8)\u003c/p\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (83.3)\u003c/p\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuppression right ventricular, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e18 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e12 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e11 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of receiving ES, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e7 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e6 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e4 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvival, n, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--Mortality\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e--Surviving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (41.2)\u003c/p\u003e\n \u003cp\u003e20 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26 (76.5)\u003c/p\u003e\n \u003cp\u003e8 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (44.8)\u003c/p\u003e\n \u003cp\u003e16 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (58.3)\u003c/p\u003e\n \u003cp\u003e5 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eEF\u003c/em\u003e Ejection fraction, \u003cem\u003ePAPs\u0026nbsp;\u003c/em\u003ePulmonary artery systolic pressure, \u003cem\u003eRV SM\u003c/em\u003e Right ventricular systolic motion, \u003cem\u003eTAPSE\u003c/em\u003e Tricuspid annular plane systolic excursion, \u003cem\u003eCRP\u003c/em\u003e C-reactive protein, \u003cem\u003ePESI\u0026nbsp;\u003c/em\u003ePulmonary embolism severity index, \u003cem\u003eDM\u0026nbsp;\u003c/em\u003eDiabetes mellitus, \u003cem\u003eHT\u0026nbsp;\u003c/em\u003eHypertension, \u003cem\u003eCAD\u003c/em\u003e Coronary artery disease, \u003cem\u003eCVD\u003c/em\u003e Cerebrovascular disease, \u003cem\u003eDVT\u003c/em\u003e Deep vein thrombosis, \u003cem\u003eTR\u0026nbsp;\u003c/em\u003eTricuspid regurgitation, \u003cem\u003eES\u003c/em\u003e Erythrocyte suspension\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eCox regression results for the predictors of mortality\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;75 age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eLytic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e6,050 (1,910-19,161)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHeart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1.014 (0.993-1.036)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65-74 age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eLytic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1.375 (0.322-5.875)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.975 (0.925-1.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Elderly patient, Massive pulmonary embolism, Thrombolytic therapy, Complications, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-7234068/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7234068/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study results showed that the mortality group had a significantly higher mean age (79.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 vs. 76\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2, p\u0026thinsp;=\u0026thinsp;0.04). Key clinical features such as RV SM (p\u0026thinsp;=\u0026thinsp;0.004) and PESI score (p\u0026thinsp;=\u0026thinsp;0.03) were significantly different between the groups. Regarding TT, patients who received thrombolysis were younger (p\u0026thinsp;=\u0026thinsp;0.004) and had a higher EF (p\u0026thinsp;=\u0026thinsp;0.048). Additionally, RV SM was significantly higher in the TT group (p\u0026thinsp;=\u0026thinsp;0.04), suggesting better overall RV function in treated patients. Mortality rates were significantly lower in the TT group (p\u0026thinsp;=\u0026thinsp;0.003). Cox regression analysis identified that receiving TT in patients aged over 75 years was an independent predictor for reduced mortality (HR\u0026thinsp;=\u0026thinsp;6.05, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Does thrombolytic therapy reduce mortality in elderly patients with pulmonary embolism?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 11:57:58","doi":"10.21203/rs.3.rs-7234068/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b6f2426-d6b4-4ad2-a4c2-d5258eee0b81","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-05T10:38:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 11:57:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7234068","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7234068","identity":"rs-7234068","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}