286 ROMANIAN MEDICAL JOURNAL – VOLUME LXVII, NO. 3, 2020 CLINICAL STUDIES Ref: Ro Med J. 2020;67(3) DOI: 10.37897/RMJ.2020.3.8 The effects of thrombolytic therapy on prognostic clinical markers in patients with intermediate-high risk pulmonary embolism Corresponding author: Alexandru Cristian Ion E-mail: cristianionmed@yahoo.com ABSTRACT The objective of the study is to assess the efect of thrombolitic therapy on clinical prognostic markers in pa- tients with intermediate-high risk pulmonary embolism compared to clasic therapy, and also the assessment of the bleeding risk associated with thrombolitic therapy. Material and methods. We included 82 consecutive patients with intermediate-high risk pulmonary embo- lism, which were divided in two groups: study group (thrombolysed) and control group (treated with unfrac- tioned heparine alone). Patients with lower bleeding risk were included in control group. Patients were as- sessed regarding the right ventricle dysfunction markers (both imagistic and biochemical) on admision and on 48 h. The early (7th day) mortality rate and hemodinamic instability rate were evaluated in the two groups, also the major bleeding rate. Outcomes. We proved a statistical significant lower mortality rate in the study group, with no difference re- garding the major bleedings. Meanwhile, the hemodinamic instability was lower in the study group compared to control group. Conclusions. The proper patient selection with intermediate-high pulmonary embolism for thrombolitic ther- apy can bring important benefits in terms of mortality and bleeding complications. Keywords: pulmonary emobolism, intermediary-high risk, trombolysis, mortality rate, thrombolitic therapy Abbreviations used PE – pulmonary embolism DVT – deep venous thrombosis BNP – brain natriuretic peptide Nt pro BNP – N terminal pro brain natriuretic peptide RV – right ventricle PESI – pulmonary embolism severity index VTE – venous thromboembolism ESC – European Society of Cardiology TAPSE – tricuspid annulus pick systolic excursion MCV – myocardial contraction velocity LV – left ventricle t-PA – tissue plasminogen activator (alteplase) aPTT – partially activated prothrombin time UFH – unfractionated heparine BMI – body mass index ISTH – International Society of Thrombosis and Hemostasis SBP – systolic blood presure HR – heart rate COPD – chronic obstructive pulmonary disease CHF – chronic heart failure BACKGROUND Pulmonary embolism (PE) is a medical condi- tion with an increasing incidence, given the in- creasing frequency of predisposing risk factors. Together with deep vein thrombosis (DVT) is a clinical continuum, explained by the fact that the most common source of thrombi in the pulmonary arterial system is found in the deep venous system. Alexandru Cristian Ion 1,2 , Stefan Busnatu 1,2 , Catalina Liliana Andrei 1,2 , Cristinel Dumitru Badiu 1,3 , Crina Julieta Sinescu 1,2 1 “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania 2 Cardiology Department, “Bagdasar-Arseni“ Emergency Hospital, Bucharest, Romania 3 Surgery Department, “Bagdasar-Arseni“ Emergency Hospital, Bucharest, Romania Article History: Received: 3 September 2020 Accepted: 14 September 2020