scholarly journals Thrombolytic therapy for pulmonary embolism: lessons from recent clinical trials

2015 ◽  
Vol 3 (4) ◽  
Author(s):  
Lexin Wang
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Clinical Studies ◽  
Massive Pulmonary Embolism ◽  
Common Disease ◽  
Thrombolytic Treatment ◽  
Normal Blood Pressure ◽  
Life Saving ◽  
Submassive Pulmonary Embolism

Pulmonary embolism is a common disease that is associated with significant mobility and mortality. Thrombolysis is potentially life saving when used in conjunction with anticoagulant therapy. Indications for thrombolysis for pulmonary embolism are not well defined. In patients with acute massive pulmonary embolism and hypotension, thrombolytic therapy offers some benefits in terms of mortality reduction. The use of thrombolysis in patients with stable haemodynamics has been controversial for more than two decades. Recent clinical studies have indicated that thrombolytic treatment in conjunction with heparin in patients with submassive pulmonary embolism and normal blood pressure can prevent deterioration of the disease and diminish the need for more intensive therapies during hospitalisation. The role of prehospital thrombolytic therapy for acute pulmonary embolism is unclear and further clinical studies are warranted.

scholarly journals The Results of Thrombolytic Treatment in Patients With High-risk Pulmonary Embolism

2019 ◽  
Vol 5 (3) ◽  
pp. 92-98
Author(s):  
Ali Ekber Atas ◽  
Atilla Sarac ◽  
Adem Dirican ◽  
Nazlı Topbası ◽  
Tugce Uzar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Cardiopulmonary Arrest ◽  
Clinical Status ◽  
Massive Pulmonary Embolism ◽  
Pulmonary Medicine ◽  
Thrombolytic Treatment ◽  
Life Saving ◽  
Key Indicators ◽  
Overall Mortality

Abstract Background: Mortality rates due to massive pulmonary embolism (PE) are much higher than estimated. Although thrombolytic therapy is controversial, it can be a life-saving procedure and can be safely used in patients with massive PE. Study aim: We aimed to share the results of thrombolytic treatment in patients with massive PE. Material and methods: We retrospectively evaluated 72 patients with PE admitted between January 2010 and April 2018 to the Department of Pulmonary Medicine, VM Medicalpark Samsun Hospital, Samsun, Turkey. The data of patients who received thrombolytic treatment were retrospectively analyzed. Results: The female to male ratio was 24/48, with a mean age of 62.7 ± 12.6 (minimum 27, maximum 88) years. The diagnosis of massive PE was established with echocardiography in all patients and was confirmed via pulmonary CT angiography in 45 patients (62.5%) who presented an appropriate clinical status for this imaging technique. The most common symptoms were dyspnea (90.3%), chest pain (83.3%), and syncope (40.2%). The S1Q3T3 electrocardiography pattern was noted in 82% of patients, who rapidly recovered after thrombolytic therapy. Cardiopulmonary arrest was seen in 25 patients (37.2%), and thrombolytic treatment was administered during cardiopulmonary resuscitation in 18% (n = 13) of patients. The survival rate was 30.7% (n = 4) in patients with cardiopulmonary arrest who received thrombolytic treatment in the emergency room. The complications of rt-PA treatment included minor hemorrhages in 6.4% (n = 5), major hemorrhages in 2.7% (n = 2), and allergic reactions in 1.3% (n = 1) of patients. None of the patients had deceased as a complication of thrombolytic treatment. The overall mortality rate was 26.2% (n = 19), and 12.5% (n = 9) of the patients have died in first 24 hours after thrombolysis. Conclusions: We concluded that the risk factors, ECG, and echocardiography are key indicators for the suspicion of massive PE in patients with hemodynamic shock. Based on our experience, early thrombolytic therapy is a life-saving intervention in patients with diagnosed and/or suspected massive PE.

scholarly journals Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis

2019 ◽  
Author(s):  
Ricardo Cleto Marinho ◽  
José Luis Martins ◽  
Susana Costa ◽  
Rui Baptista ◽  
Lino Gonçalves ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pericardial Effusion ◽  
Thrombolytic Therapy ◽  
Cardiac Tamponade ◽  
Massive Pulmonary Embolism ◽  
Extensive Study ◽  
Life Saving ◽  
Obstructive Shock

Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases.

Role of rheolytic thrombectomy in massive pulmonary embolism with contraindication to systemic thrombolytic therapy

2010 ◽  
Vol 5 (6) ◽  
pp. 716-721 ◽  
Author(s):  
Dabit Arzamendi ◽  
Luc Bilodeau ◽  
Reda Ibrahim ◽  
Stephane Noble ◽  
Richard Gallo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Massive Pulmonary Embolism ◽  
Systemic Thrombolytic Therapy ◽  
Rheolytic Thrombectomy

scholarly journals The Role of Thrombolytic Therapy for Patients with a Submassive Pulmonary Embolism

Cureus ◽  
2018 ◽  
Author(s):  
Elizabeth Murphy ◽  
Ahmed Lababidi ◽  
Renuka Reddy ◽  
Taaha Mendha ◽  
David Lebowitz
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Submassive Pulmonary Embolism

scholarly journals Clinical outcomes of submassive pulmonary embolism thrombolysis—an Indian experience

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Nadeem U. Rehman ◽  
Mohd Iqbal Dar ◽  
Manish Bansal ◽  
R. R. Kasliwal
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Systolic Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Post Treatment ◽  
Control Group ◽  
Submassive Pulmonary Embolism ◽  
Venous Thromboembolic ◽  
Pre Treatment ◽  
And Control

Abstract Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboembolic disease. The role of thrombolysis in massive pulmonary embolism has been studied extensively, but the same is not there for submassive pulmonary embolism. This study is aimed at evaluating the effects of thrombolysis in acute submassive pulmonary embolism. This was a prospective, case-control, observational study. Patients presenting with acute submassive pulmonary embolism were divided into thrombolysis group and control group depending on whether they received thrombolysis plus anticoagulation or anticoagulation only, respectively. Results A total of 86 patients were included in the study. Forty-two patients were in the thrombolysis group, and 44 patients were in the control group. The mean ± SD age in the control and thrombolysis groups was 63.3 ± 14.7 and 56.4 ± 13.8 years, respectively. The two groups were well matched in sex distribution and associated comorbidities like COPD, active surgery, major trauma, and immobilization. On echocardiography, dilated RA/RV in pre-treatment vs. post-treatment was seen in 20 (45.5%) vs. 20 (45.5%) in the control group and 26 (61.9%) vs. 11 (26.2%) in the thrombolysis group. Similarly, RV systolic dysfunction in pre-treatment vs. post-treatment was seen in 24 (54.5%) vs. 21 (47.7%) in the control group and 22 (52.4%) vs. 8 (19.0%) in the thrombolysis group. Pulmonary artery pressure in pre-treatment vs. post-treatment was 64.4 ± 15.0 vs. 45.9 ± 9.9 mmHg in the control group and 68.3 ± 17.4 vs. 31.4 ± 6.9 mmHg in the thrombolysis group. In control vs. thrombolysis group, there were 5 vs. 1 death, 6 vs. 1 hemodynamic decompensation, and 6 vs. 1 patient needing mechanical ventilation. Conclusion Thrombolysis in submassive pulmonary embolism is associated with better right ventricular functions, lower pulmonary artery pressures, and comparable mortality rates.

A Massive Pulmonary Embolism Treatment Protocol: How Trauma Performance Improvement Affects Outcome Throughout the Hospital System

2010 ◽  
Vol 76 (2) ◽  
pp. 145-148
Author(s):  
Catherine Garrison Velopulos ◽  
Mark Zumberg ◽  
Priscilla Mcauliffe ◽  
Lawrence Lottenberg ◽  
A. Joseph Layon
Keyword(s):  
Pulmonary Embolism ◽  
Sudden Death ◽  
Performance Improvement ◽  
Pulmonary Embolus ◽  
Treatment Protocol ◽  
Right Heart Failure ◽  
Hospital Performance ◽  
Massive Pulmonary Embolism ◽  
Hospital System ◽  
Submassive Pulmonary Embolism

Trauma performance improvement is the hallmark of a mature trauma center. If loop closure is to be complete, preventable deaths must result in significant change in management and the establishment of protocol-driven improvements so such an instance does not recur. The trauma performance improvement committee reviewed a case of a massive pulmonary embolus and determined that this was a preventable death. The hospital performance improvement committee then initiated a root cause analysis, which led to creation of a treatment protocol for patients with massive or submassive pulmonary embolism. A focused review of the first 6 months of the implementation of the protocol was undertaken. Four patients over a 6-month period had massive or submassive pulmonary embolus. All four had sudden death or near sudden death and were appropriately resuscitated. All four sustained right heart failure. Two patients were treated by catheter-directed fibrinolysis, one with catheter-directed suction embolectomy, and one by surgical pulmonary embolectomy. All survived with full neurologic function. Trauma performance improvement is the model by which all hospital performance improvement should be done. Preventable deaths can result in change, which can have a future impact on survival in potentially lethal scenarios.

scholarly journals Short-Term Mortality in Patients with Massive and Submassive Pulmonary Embolism Receiving Thrombolytic Therapy

2013 ◽  
Vol 84 (1) ◽  
pp. 62 ◽  
Author(s):  
Yun-Ju Cho ◽  
So-My Koo ◽  
Duk Won Bang ◽  
Ki-Up Kim ◽  
Soo-taek Uh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Short Term ◽  
Submassive Pulmonary Embolism ◽  
Short Term Mortality
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