Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism

Konstantinides, S.; Geibel, Annette; Heusel, Gerhard

doi:10.1016/s1062-1458(02)01002-4

Cited by 121 publications

(192 citation statements)

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“…1 Since that time, the literature regarding the treatment of acute VTE has grown dramatically. [2][3][4][5][6][7][8][9][10][11][12][13][14] However, despite the available evidence, there remains considerable controversy regarding the appropriate setting for thrombolysis in acute pulmonary embolism (PE) or deep-vein thrombosis (DVT). We therefore sought to better describe the current patterns of thrombolytic use among practicing pulmonologists and to determine if these patterns have changed over the last decade.…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic therapy for venous thromboembolism: Current clinical practice

Stashenko

Hargett

Tapson

2009

Journal of Hospital Medicine

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BACKGROUND: Venous thromboembolism (VTE) is a life‐threatening condition for which thrombolytic therapy may be beneficial. The appropriate setting for the use of thrombolytic therapy remains controversial. More than 10 years ago we described the case‐based practice patterns for the use of thrombolytics in VTE, and now, in the context of recent studies and guidelines, we sought to reevaluate the use of thrombolytics and to determine whether beliefs have changed. METHODS: Active pulmonologists in 11 southeastern states were selected to complete a web‐based questionnaire that included background questions and hypothetical case scenarios involving VTE and potential treatment with thrombolytics. RESULTS: Eighty‐one physicians completed the survey and 84% reported using thrombolytic therapy for VTE within the last 2 years. In the absence of absolute contraindications, 99% of respondents would strongly consider using systemic thrombolytic therapy for massive pulmonary embolism (PE) with hypotension, 83% would strongly consider thrombolysis for a large PE with severe hypoxemia, and 62% would strongly consider thrombolysis for PE with echocardiographic evidence of right ventricular dysfunction. In a patient with massive PE and hypotension with certain contraindications, 91% of respondents would still strongly consider thrombolysis. CONCLUSIONS: Most practicing pulmonologists would strongly consider administering thrombolytic therapy for massive PE with hypotension or hypoxemia, and a majority favor thrombolysis for PE in the setting of echocardiographic evidence of right heart dysfunction. Despite the evolving data and guidelines for the management of VTE, our findings are similar to prior survey results, emphasizing the need for further physician education and future randomized trials to clarify the therapy for this potentially deadly condition. Journal of Hospital Medicine 2009;4:313–316. © 2009 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Thrombolytic therapy for venous thromboembolism: Current clinical practice

Stashenko

Hargett

Tapson

2009

Journal of Hospital Medicine

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“…Lung type I cells comprise approximately 95% of the alveolar surface and therefore form the major area of the lung, being critical for gas exchange (8). Type II cells are crucial for basic lung functions like surfactant production and tissue repair (9). Immunofluorescence ( Figure 2C) and electron microscopy ( Figures E3 and E4) showed strong MERS-CoV antigen expression and identified intraand extracellular virions in different stages of the replication cycle …”

Section: Use Of Technetium-99m-labeled Eosinophils To Detect Active Ementioning

confidence: 99%

Use of Technetium-99m–labeled Eosinophils to Detect Active Eosinophilic Inflammation in Humans

Farahi

Loutsios

Peters

et al. 2013

Am J Respir Crit Care Med

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However, the additional flush after EVLP is expected to clear the medication from the vasculature. Furthermore, the accumulation of the drug in the extravascular space has been shown to be minimal and would have been rapidly dissipated once in vivo status had been reestablished (10). In our case there were no signs of fibrinolytic complication such as bleeding.With the success obtained in the Human Ex vivo Lung Perfusion trial and evidence from research studies demonstrating stable pulmonary function over prolonged normothermic perfusions over 12 hours, we believe that advanced lung preservation techniques should involve EVLP as a platform for accurate diagnosis and directed therapy (16). As opposed to our ongoing preclinical research using advanced molecular therapeutics such as adenoviral IL-10 gene therapy (17), in this case we used readily available clinical diagnostic techniques and a clinically proven, readily available medication to treat donor lungs in an almost guideline-based fashion, but in the ex vivo setting. Thus, this case exemplifies how the concept of personalized medicine for the donor organ can be applied in the field of lung transplantation.

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“…2 In a randomized study, 256 patients with acute PE and pulmonary hypertension or right ventricular dysfunction (but without arterial hypotension or shock) were assigned to receive either heparin plus 100 mg of alteplase or heparin plus placebo over a period of two hours. 45 The study showed that alteplase given in conjunction with heparin could prevent clinical deterioration requiring escalation of treatment. However, no difference between both treatment groups was observed in clinically relevant outcomes such as recurrent non-fatal or fatal PE.…”

Section: Thrombolysismentioning

confidence: 99%

“…At the end of the infusion of alteplase, heparin (1000 UI·hr -1 ) is started and anticoagulation is adjusted according to the aPTT. 45 For streptokinase or urokinase, heparin is usually begun when the fibrinogen level is above 1.0 g·L -1 and the aPTT less than twice the control value.…”

Section: Thrombolysismentioning

confidence: 99%