• Barret Rush, Katie Wiskar, Landon Berger, and Donald E Griesdale.
• Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada; Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
• J Emerg Med. 2017 May 1; 52 (5): 615-621.

BackgroundThrombolysis for the treatment of pulmonary embolism (PE) has received significant attention in the literature over the past 10 years.ObjectiveOur primary objective was to examine the trend in thrombolysis use in the United States from 2006 to 2011. Secondary objectives include examining patient and hospital characteristics associated with receiving thrombolysis and rates of complications associated with thrombolysis.MethodsIn this retrospective cohort study, we used the Nationwide Inpatient Sample from 2006 to 2011 to identify patients with a diagnosis of PE who received or did not receive thrombolytic agents.ResultsExamining the records of 47,911,414 hospital discharges identified a cohort of 1,317,329 patients with PE; of these patients, 10,617 received thrombolysis. During the study period, there was a 30% relative increase in the use of thrombolysis, from 0.68% (95% confidence interval [CI] 0.64-0.73%) to 0.89% (95% CI 0.83-0.95%; p < 0.01). After controlling for all factors in the model, factors associated with decreased access to thrombolysis were increasing age (odds ratio [OR] 0.981 [95% CI 0.980-0.982]; p < 0.01), female sex (OR 0.78 [95% CI 0.75-0.81]; p < 0.01), Black race (OR 0.86 [95% CI 0.81-0.91]; p < 0.01), Hispanic race (OR 0.78 [95% CI 0.71-0.86]; p < 0.01), other race (OR 0.72 [95% CI 0.59-0.88]; p = 0.02), and rural hospital location (OR 0.48 [95% CI 0.43-0.52]; p < 0.01).ConclusionsThe use of thrombolysis increased between 2006 and 2011 in the United States. Patients who receive thrombolysis tend to be white men, live in higher-income ZIP codes, and receive the therapy at large academic teaching hospitals.Copyright © 2016 Elsevier Inc. All rights reserved.

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