Observational Investigation of Thrombolysis With the Tissue-Type Plasminogen Activator Monteplase for Acute Pulmonary Embolism in Japan

Niwa, Akira; Nakamura, Mashio; Harada, Natsumi; Musha, Takashi

doi:10.1253/circj.cj-12-0091

Cited by 14 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Monteplase, a genetic recombinant tissue-type plasminogen activator, is highly effective for acute pulmonary embolism and offers acceptable safety for severe bleeding complications. 6 …”

Section: Discussionmentioning

confidence: 99%

Visualization of Thrombosis on a Prosthetic Pulmonary Valve Using Electrocardiogram-Gated Multidetector Computed Tomography

Kakizaki

Tazawa

Kure

et al. 2014

THORAC CARDIOV SURG Reports

View full text Add to dashboard Cite

We report a case of prosthetic valve thrombosis in an 18-year-old man. Total surgical repair of tetralogy of Fallot was performed at 3 years of age. At the age of 18, he underwent pulmonary valve replacement because of exacerbating pulmonary trunk obstruction. After surgery, valve malfunction was suspected. We attempted to employ electrocardiogram (ECG)-gated multidetector computed tomography (MDCT). The stuck valve was clearly visualized together with a thrombus within. Thrombolytic therapy was undertaken on these findings. ECG-gated MDCT allowed us to make a definitive diagnosis of valve thrombosis as the cause of valve malfunction, which led us to avoid surgical reintervention.

show abstract

“…Monteplase, a genetic recombinant tissue-type plasminogen activator, is highly effective for acute pulmonary embolism and offers acceptable safety for severe bleeding complications. 6 …”

Section: Discussionmentioning

confidence: 99%

Visualization of Thrombosis on a Prosthetic Pulmonary Valve Using Electrocardiogram-Gated Multidetector Computed Tomography

Kakizaki

Tazawa

Kure

et al. 2014

THORAC CARDIOV SURG Reports

View full text Add to dashboard Cite

show abstract

“…Thrombolysis has been studied in these patients and does not yield any benefit on mortality. 18, 19 Thrombolysis decreased the risk of clinical deterioration by 3-fold, but was associated with a 3-fold higher risk of major bleeding. 4,20,21 Therefore, thrombolysis in cases of submassive PE is not recommended despite its potential effect on RV dilatation and function.…”

Section: Discussionmentioning

confidence: 99%

Diuretics in Normotensive Patients With Acute Pulmonary Embolism and Right Ventricular Dilatation

Ternacle

Gallet

Mekontso-Dessap

et al. 2013

Circ J

View full text Add to dashboard Cite

“…Accelerated regimens involving administration of tissue plasminogen activator (t-PA) during a 2-h period are preferable to prolonged infusions of first-generation thrombolytic agents during a 12- to 24-h period [ 34 ]. Compared with the properties of native t-PA, third-generation bioengineered thrombolytic agents (tenecteplase and monteplase) have a longer half-life, greater clot sensitivity, and more rapid lytic capacity [ 19 , 35 , 36 ]. Monteplase has been approved for acute PE with hemodynamic instability in Japan [ 35 , 36 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of patients with high-risk pulmonary embolism: a narrative review

Yamamoto

2018

j intensive care

View full text Add to dashboard Cite

High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Most deaths in patients with shock occur within the first few hours after presentation, and rapid diagnosis and treatment is therefore essential to save patients’ lives. The main manifestations of major PE are acute right ventricular (RV) failure and hypoxia. RV pressure overload is predominantly related to the interaction between the mechanical pulmonary vascular obstruction and the underlying cardiopulmonary status. Computed tomography angiography allows not only adequate visualization of the pulmonary thromboemboli down to at least the segmental level but also RV enlargement as an indicator of RV dysfunction. Bedside echocardiography is an acceptable alternative under such circumstances. Although it does not usually provide a definitive diagnosis or exclude pulmonary embolism, echocardiography can confirm or exclude severe RV pressure overload and dysfunction. Extracorporeal membrane oxygenation support can be an effective procedure in patients with PE-induced circulatory collapse. Thrombolysis is generally accepted in unstable patients with high-risk PE; however, thrombolytic agents cannot be fully administered to patients with a high risk of bleeding. Conversely, catheter-directed treatment is an optimal treatment strategy for patients with high-risk PE who have contraindications for thrombolysis and is a minimally invasive alternative to surgical embolectomy. It can be performed with a minimum dose of thrombolytic agents or without, and it can be combined with various procedures including catheter fragmentation or embolectomy in accordance with the extent of the thrombus on a pulmonary angiogram. Hybrid catheter-directed treatment can reduce a rapid heart rate and high pulmonary artery pressure and can improve the gas exchange indices and outcomes. Surgical embolectomy is also performed in patients with contraindications for or an inadequate response to thrombolysis. Large hospitals having an intensive care unit should preemptively establish diagnostic and therapeutic protocols and rehearse multidisciplinary management for patients with high-risk PE. Coordination with a skilled team comprising intensivists, cardiologists, cardiac surgeons, radiologists, and other specialists is crucial to maximize success.

show abstract

Observational Investigation of Thrombolysis With the Tissue-Type Plasminogen Activator Monteplase for Acute Pulmonary Embolism in Japan

Cited by 14 publications

References 16 publications

Visualization of Thrombosis on a Prosthetic Pulmonary Valve Using Electrocardiogram-Gated Multidetector Computed Tomography

Visualization of Thrombosis on a Prosthetic Pulmonary Valve Using Electrocardiogram-Gated Multidetector Computed Tomography

Diuretics in Normotensive Patients With Acute Pulmonary Embolism and Right Ventricular Dilatation

Management of patients with high-risk pulmonary embolism: a narrative review

Contact Info

Product

Resources

About