scholarly journals Should systemic thrombolytic therapy be considered a first-line treatment in acute pulmonary embolism?

2015 ◽  
Vol 15 (1) ◽  
pp. 82-83
Author(s):  
Orhan Gokalp ◽  
Yuksel Besir ◽  
Bortecin Eygi ◽  
Gamze Gokalp
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Line Treatment ◽  
First Line ◽  
Systemic Thrombolytic Therapy ◽  
First Line Treatment

Catheter-directed therapy as a first-line treatment strategy in hemodynamically unstable patients with acute pulmonary embolism: Yes or no?

2016 ◽  
Vol 225 ◽  
pp. 14-15 ◽  
Author(s):  
Marco Zuin ◽  
William T. Kuo ◽  
Gianluca Rigatelli ◽  
Ramesh Daggubati ◽  
Dobrin Vassiliev ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Treatment Strategy ◽  
Acute Pulmonary Embolism ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Prolonged Chest Compressions during Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest due to Acute Pulmonary Embolism

2015 ◽  
Vol 42 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Carla Nobre ◽  
Boban Thomas ◽  
Luis Santos ◽  
João Tavares
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Cardiopulmonary Arrest ◽  
Hemodynamic Instability ◽  
Circulatory Support ◽  
Chest Compressions ◽  
Output State ◽  
Dismal Prognosis ◽  
Systemic Thrombolytic Therapy

Patients with hemodynamic collapse due to acute pulmonary embolism have a dismal prognosis if not treated rapidly. Therapeutic options include systemic thrombolytic therapy, rheolytic thrombectomy, and surgical embolectomy. However, the efficacy of thrombolytic therapy is diminished because the low-output state hinders effective delivery of the lytic agent to the thrombus. In the absence of any form of mechanical circulatory support, such as extracorporeal membrane oxygenation or cardiac surgery on site, we think that prolonged vigorous manual compressions might be the only way to support the circulation during the initial critical state, when thrombolytic therapy has been administered. We report the results of prolonged manual chest compressions (exceeding 30 minutes) on 6 patients who received tenecteplase in treatment of acute pulmonary embolism that induced in-hospital cardiopulmonary arrest. Four of 6 patients survived and were discharged from the hospital. In an era of increasing technologic complexity for patients with hemodynamic instability, we emphasize the importance of prolonged chest compressions, which can improve systemic perfusion, counteract the prothrombotic state associated with cardiopulmonary arrest, and give the lytic agent time to act.

scholarly journals Coagulation properties of the blood coagulation system in acute pulmonary embolism and their dynamics against the background of systemic thrombolytic therapy for patients with different risk of hospital mortality

2020 ◽  
Vol 27 (1) ◽  
pp. 27-38
Author(s):  
O. A. Koval ◽  
O. M. Klygunenko ◽  
O. Yu. Muryzina
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Mortality Risk ◽  
Fibrinolytic Activity ◽  
Acute Pulmonary Embolism ◽  
Activated Partial Thromboplastin Time ◽  
Systemic Thrombolytic Therapy ◽  
Group 2 ◽  
Group 1

The aim – to evaluate the dynamics of blood coagulation changes in patients with acute pulmonary embolism before and after systemic thrombolytic therapy (TLT), by comparing high and intermediate-high risk groups. Materials and methods. 45 patients, 29 male (62 %) and 17 female (38 %), 55.6±13.6 years old admitted into an intensive care unit with the first episode of acute PE and received systemic thrombolysis, were included into prospective nonrandomized investigation. Accoding to the ESC Guideline on pulmonary embolism (2014) these patients were split into two groups: unstable high-risk pulmonary embolism patients having or hypotension or episodes of syncope (group 1, n=28, 62 %), and patients with intermediate-high mortality risk with stable hemodynamic indexes (group 2, n=17, 38 %) but with massive bilateral embolism (U1-2=2.2, p=0.33), verified by multispiral computed tomography pulmonary angiography (angio-regimen), hemodynamically overload, with signs of right and ventricular dysfunction and positive troponin tests. The 30-day mortality risk for PESI corresponds to Grade V (IV): 152 ± 19 points in group 1, 138.0±9.7 in group 2 (p1-2<0.01). Results and discussion. In both groups, a similar (p1-2>0.25) initial procoagulant status was revealed by changes in thrombin formation indexes: prothrombin time (PT) increased to 19.8 [16, 23] sec, and prothrombin index increased to 96.1 % [86, 106], reduction of activated partial thromboplastin time to 23.5 [21, 24] sec. The content of the main coagulation substrate fibrinogen increased up to 4.3 [4.1, 4.5] g/l (p1-2=0.25), and markers of thrombinemia increased as follows: soluble fibrin up to 17.0 [16, 18] mg, D-dimer up to 5214 [3605, 5643] ng/ml. The systemic fibrinolytic activity was initially suppressed: the values of spontaneous fibrinolysis were reduced to 9.5 [6.0, 12.2] %, self-retraction – to 31.9 [26.1, 36.1] %. On the 5th day after the TLT on the background of basic therapy, the following dynamics was observed: increase of (Z=5.62, p<0.00001) activated partial thromboplastin time values – up to 46.1 ± 6.0 s (p1-2=0.36) and PT – up to 22.9 (18–26) s, while fibrinogen decreased – down to 3.5 g/l. Despite favorable changes, markers of thrombinemia remained increased: although fibrin values decreased (Z=3.03, p<0.001) to 13.7 mg, but still exceeded the upper limit of the reference range in both groups (p1-2=0.21). The values of spontaneous fibrinolysis increased to 11.9 % [9.9, 12.4], and self-retraction (Z=0.64, p<0.01) to 32.0 % [27.9, 33.0], remaining significantly lower than the reference level and indicating high risk of relapse of thromboembolic events. Conclusions. For patients with acute pulmonary embolism, regardless of the presence of high or intermediate-high risk, according to the main coagulation indexes, the procoagulant state of hemostasis, inhibition of fibrinolytic activity, decrease in clot density in vitro are identical in strength and direction. On the 5th day after TLT on the basic anticoagulation therapy and despite a certain level of therapeutic anticoagulation, a rather high level of markers of thrombinemia, inhibition of fibrinolysis and retraction persists. The presence of the same coagulation changes in strength and orientation, the depletion of fibrinolytic mechanisms of hemostasis, the positive clinical impact of TLT in the intermediate-high risk group supports indications for TLT in this group of patients.

scholarly journals Clinical outcomes of acute pulmonary embolectomy as the first-line treatment for massive and submassive pulmonary embolism: a single-centre study in China

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Wang QiMin ◽  
Chen LiangWan ◽  
Chen DaoZhong ◽  
Qiu HanFan ◽  
Huang ZhongYao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mortality Rate ◽  
Line Treatment ◽  
First Line ◽  
Single Centre ◽  
Right Ventricle Function ◽  
Systemic Thrombolysis ◽  
Acute Pe ◽  
First Line Treatment ◽  
Ventricle Function

Abstract Background Acute pulmonary embolism (PE) is one of the most critical cardiovascular diseases. PE treatment ranges from anticoagulation, and systemic thrombolysis to surgical embolectomy and catheter embolectomy. Surgical pulmonary embolectmy (SPE) indications and outcomes are still controversial. Although there have been more favourable SPE reports over the past decades, SPE has not yet been considered broadly as an initial PE therapy and is still considered as a reserve or rescue treatment for acute massive PE when systemic thrombolysis fails. This study aimed to evaluate the early and midterm outcomes of SPE, which was a first-line therapy for acute central major PE in one Chinese single centre. Methods A retrospective review of patients who underwent SPE for acute PE was conducted.Patients with chronic thrombus or who underwent thromboendarterectomy were excluded. SPE risk factors for morbidity and mortality were reviewed, and echocardiographic examination were conducted for follow-up studies to access right ventricular function. Results Overall, 41 patients were included; 17 (41.5%) had submassive PE, and 24 (58.5%) had massive PE. Mean cardiopulmonary bypass time was 103.2 ± 48.9 min, and 10 patients (24.4%) underwent procedures without aortic cross-clamping. Ventilatory support time was 78 h (range, 40–336 h), intensive care unit stay was 7 days (range, 3–13 days), and hospital stay was 16 days (range, 12–23 days). Operative mortalities occurred in 3 massive PE patients, and no mortality occurred in submassive PE patients. The overall SPE mortality rate was 7.31% (3/41). If two systemic thrombolysis cases were excluded, SPE mortality was low (2.56%,1/39), evenlthough there were 2 cases of cardiac arrest preoperatively. Patients’ right ventricle function improved postoperatively in follow-ups.There were no deaths related to recurrent PE and chronic pulmonary hypertension in follow-ups, though 3 patients died of cerebral intracranial bleeding, gastric cancer,and brain cancer at 1 year, 3 years, and 8 years postoperatively, respectively. Conclusions SPE presented with a low mortality rate when rendered as a first-line treatment in selected massive and submassive acute PE patients. Favorable outcomes of right ventricle function were also observed in the follow-ups. SPE should play the same role as ST in algorithmic acute PE treatment.

Massive pulmonary embolism in a young boy with T-cell leukaemia

2014 ◽  
Vol 34 (03) ◽  
pp. 233-236
Author(s):  
C. Martin ◽  
F. Alt ◽  
A. Wingerter ◽  
G. Staatz ◽  
H. Schinzel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Bleeding Complications ◽  
Cell Leukaemia ◽  
Malignant Diseases ◽  
Systemic Thrombolytic Therapy ◽  
Tissue Plasminogen

SummaryAcute pulmonary embolism (PE) is a serious complication in association with malignant diseases. We describe the successful treatment of PE applying a systemic thrombolytic therapy in a 4-year-old boy with acute lymphoblastic leukaemia.The thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) 0.1 mg/ kg bodyweight per hour for six hours was continued for six days without important side effects. In particular no bleeding complications were observed. Computed tomography with contrast revealed a remarkable regression of the central PE. Without further delays the chemotherapy was resumed.

scholarly journals Clinical Outcome of Acute Pulmonary Embolectomy Taken as to be the First Line Treatment for Massive and Submassive Pulmonary Embolism: Experience from One Single Center in China

2020 ◽  
Author(s):  
Wang QiMin ◽  
Chen Liangwan ◽  
Chen Daozhong ◽  
Qiu Hanfan ◽  
Huang Zhongyao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Single Center ◽  
First Line ◽  
Pulmonary Embolectomy ◽  
Submassive Pulmonary Embolism ◽  
Surgical Embolectomy ◽  
First Line Treatment

Abstract Backgroud: Acute pulmonary embolism (PE) is one of the most critical cardiovascular disease. The treatment for PE depends on the severity of disease including anticoagulation, systemic thrombolysis, surgical embolectomy,and catheter embolectomy. The indication of surgical pulmonary embolectomy is still controvery. Although there have been more favourable reports of the of surgical embolectomy (SE) over past decades, SE has still been used as a resort or rescue treatment for acute massive PE with significant hemodynamically unstable or present with cardiogenic shock or patients whose thrombolysis failed，therefore the high mortality of pulmonary surgical embolectomy was still reported. SE has not yet been accepted broadly as initial therapy in the algorithm for massive and submassive PE.Objective : The purpose of this study is to evaluate the early and midterm outcome of surgical pulmonary embolectomy which was taken as the first line therapy for acute central major pulmonary embolism in one single center in ChinaMethods: A retrospective review of patients who underwent surgical pulmonary embolectomy for acute pulmonary embolectomy was conducted from July of 2005 to Sept of 2019 at a single heart center in China. Patients with chronic thrombus or thrombendrterectomy were excluded.The risk factors for morbidity and mortality of the surgical pulmonary embolectomy were reviewed, The institutional echocardiographic database was searched for follow-up studies to compare markers of right ventricular function.Results: A total of 41 patients were included for the study, 17 cases (41.5%) had submassive PE and 24 (58.5%) had massive pulmonary embolism required preoperative positive inotropic treatment. Mean cardiopulmonary bypass time was 103.2±48.9 minutes, and 10 patients (24.4.%) underwent procedures without aortic cross-clamping. Ventilatory support time was 80.6±21.3hours. ICU stay was 4.51±3.23 days. Hospital stay was 12.8±6.4days. There was operative mortality 3 (7.32%) for massive pulmonary embolism and no death case of submassive pulmonary embolism. For massive PE patients, if the first choice treatment was surgical embolectomy, the mortality was low,only 2.56%, even though there were 2 cases suffered from cardiac arrest preoperatively. However, if 2 cases who received systemic thromblysis firstly were included in the datus,the mortality rate of SE increased to 12.5%. All cases had echocardiography results available for follow-up at discharge,and 30 cases at three months, only 10 cases at one years after surgical embolectomy. There were no death event related with recurrent PE in the follow-up,but 3 patents died of cerebral incranal bleeding, gastric cancer and gastric cancer at 1 year,3 years and 8 years after surgical embolectomy respectively.Conclusions: In this small retrospective single center experience, SE presented with low mortality rate when it was rendered as the first line treatment in selected patients for massive and submassive acute pulmonary embolism. SE should play the the same role as ST in the treatment algorithm for acute PE. Echocardiographic showed right ventricular function was improved in the early and midterm follow- up term

Aneurysmen des venösen Systems

Phlebologie ◽  
2016 ◽  
Vol 45 (03) ◽  
pp. 146-148 ◽  
Author(s):  
T. Noppeney ◽  
J. Noppeney
Keyword(s):  
Pulmonary Embolism ◽  
Jugular Vein ◽  
External Jugular Vein ◽  
Venous System ◽  
Line Treatment ◽  
First Line ◽  
Third Place ◽  
Thrombotic Occlusion ◽  
First Line Treatment

SummaryOverall, aneurysms of the venous system constitute a rare disease. Up to March 2016, 1,199 venous aneurysms at various locations had been reported in the literature. The most common were aneurysms of the extrahepatic portal vein (n=247), followed by popliteal venous aneurysms (n=223) and, in third place, aneurysms of the internal or external jugular vein (n=143). Venous aneurysms are not usually diagnosed until they have become symptomatic or have led to complications, such as thrombosis and/or pulmonary embolism. First-line treatment of symptomatic aneurysms is resection of the aneurysm and reconstruction of the vein using either direct suture or end-to-end anastomosis, depending on the location. Endovenous repairs have also been described in the literature. Venous aneurysms of the superficial venous system can usually be excised and the vein ligated. Long-term anticoagulation is reserved for isolated cases with thrombotic occlusion and recurrent pulmonary embolisms.

scholarly journals Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis

2014 ◽  
Vol 36 (10) ◽  
pp. 605-614 ◽  
Author(s):  
Christophe Marti ◽  
Gregor John ◽  
Stavros Konstantinides ◽  
Christophe Combescure ◽  
Olivier Sanchez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Meta Analysis ◽  
Systemic Thrombolytic Therapy
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