Heparin plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism

Konstantinides, Stavros; Geibel, Annette; Heusel, Gerhard; Heinrich, Fritz; Kasper, Wolfgang

doi:10.1056/nejmoa021274

Cited by 885 publications

(410 citation statements)

References 30 publications

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“…In contrast patient with elevated cardiac markers may require immediate triage for ICU, urgent thrombolysis [18] and catheter embolectomy [19] or open surgical embolectomy [20]. Kostrubiec et al, 2007 [21] found that persistent elevation of NT-pro BNP 24 hours after diagnosis (reduction of less than 50% from initial values) predicts higher mortality at thirty days.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Selem¹,

Radwan²,

Gomaa³

2012

OJEMD

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Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% vs 54.5%, p = 0.006) and cardiogenic shock (26.2% vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% vs 9.1%, p =0.021) and positive inotropics (35.71% vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Selem¹,

Radwan²,

Gomaa³

2012

OJEMD

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“…[4][5][6][7][8][9][10][11][12] Our results were in agreement with those in previous reports. Although right ventricular dysfunction has recently drawn attention as a prognostic factor of APTE, [19][20][21][22][23] the relationship between thrombolysis and outcome in patients with right ventricular dysfunction was not evaluated in the present study because not all of the study subjects underwent echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we did not investigate the association between right ventricular function and the clinical outcomes, which was done in previous reports. [19][20][21][22][23] Finally, this study included patients for 25 consecutive years. During this period there have been significant developments in APTE management: more effective tools such as inferior vena cava filters 26,27 and venous ultrasounds 28,29 have recently become available.…”

Section: Study Limitationsmentioning

confidence: 99%

Association Between Antithrombotic Treatments and Prognosis of Patients With Acute Pulmonary Thromboembolism in Japan

Ota

Nakamura

Yamada

et al. 2003

Circ J

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“…The authors claim that this study proves the benefit of systemic thrombolysis in well-defined patients and that thrombolysis should therefore be considered routinely as an option in those patients [40]. Opponents argue that the difference in outcome was exclusively due to the frequency of secondary thrombolysis within the first 4 days and to a treatment escalation which had no objective measure but was left entirely to the discretion of the attending physician.…”

Section: Systemic Thrombolysismentioning

confidence: 93%

“…Konstantinides et al [40]conducted a randomized controlled trial from 1997 to 2001, enrolling 256 patients with submassive PE at 49 study sites. Hemodynamically stable patients with significant right ventricular dysfunction were randomized to receive either 100 mg of alteplase over 2 h or placebo.…”

Section: Systemic Thrombolysismentioning

confidence: 99%

New Therapeutic Approaches in Pulmonary Embolism

Schellong¹,

Schmidt²

2003

Respiration

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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis.

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Heparin plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism

Abstract: When given in conjunction with heparin, alteplase can improve the clinical course of stable patients who have acute submassive pulmonary embolism and can prevent clinical deterioration requiring the escalation of treatment during the hospital stay.

Cited by 885 publications

References 30 publications

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Association Between Antithrombotic Treatments and Prognosis of Patients With Acute Pulmonary Thromboembolism in Japan

New Therapeutic Approaches in Pulmonary Embolism

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