Predictors of Major Hemorrhage Following Fibrinolysis for Acute Pulmonary Embolism

Fiumara, Karen; Kucher, Nils; Fanikos, John; Goldhaber, Samuel Z.

doi:10.1016/j.amjcard.2005.07.117

Cited by 142 publications

(88 citation statements)

References 12 publications

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“…14 In Western countries, the range of reported incidence of ICH is similar, ranging from 0.5% 18 to 3.0% 19 to 5.0%. 17 In the present study, the incidence of ICH was not dependent on monteplase dose or acute PE severity.…”

Section: Discussionmentioning

confidence: 57%

“…Fiumara et al highlighted hemodynamic instability as an important factor contributing to severe hemorrhage. 17 Moreover, in CPA/collapse cases, there is a high rate of performing PAG and PCPS. It is considered that the vascular puncture associated with these procedures might be related to the high incidence of severe bleeding complications in severe acute PE patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Niwa

Nakamura

Harada

et al. 2012

Circ J

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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

Niwa

Nakamura

Harada

et al. 2012

Circ J

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“…20 Furthermore, major bleeding has been reported to occur in up to 20% of patients receiving fibrinolysis for acute PE. 24 Therefore, some clinicians are hesitant to routinely prescribe such treatment to patients who appear to be hemodynamically stable, particularly in the face of a lack of definitive evidence.…”

Section: Discussionmentioning

confidence: 99%

Submassive Pulmonary Embolism

et al. 2013

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ForewordInformation about a real patient is presented in stages (boldface type) to expert clinicians (Drs Louis J. Dell'Italia and David C. McGiffin) who respond to the information, sharing his or her reasoning with the reader (regular type). A discussion by the authors follows.A 67-year-old black woman presents to the emergency department with a 1-day history of dyspnea, which began the previous morning initially with moderate exertion now progressing to dyspnea at rest. She denies chest pain, cough, palpitations, nausea, diaphoresis, lower extremity swelling, paroxysmal nocturnal dyspnea, orthopnea, presyncope, or syncope. Her medical history is notable for hypertension, diabetes mellitus, and hypothyroidism. Her medications include metoprolol tartrate 12.5 mg twice daily, metformin 1000 mg twice daily, levothyroxine 25 μg daily, and estradiol 1 mg daily for symptomatic management of hot flashes. She lives alone and is a retired schoolteacher. She does not smoke, drink alcohol, or use illicit drugs. Family history is not significant. Travel history is notable for round-trip plane flight from Alabama to Utah, arriving home 2 days previously.On physical examination her temperature is 98.4°F, pulse is 94 beats/min, blood pressure is 112/55 mm Hg in the right arm, 110/58 mm Hg in the left arm, respiratory rate 26 breaths/min, and oxygen saturation 90% on room air. She is an obese black woman (body mass index 32 kg/m 2 ) in mild distress secondary to shortness of breath. Jugular venous pressure is estimated at 14 cm H 2 0. Lungs are clear to auscultation. The heart rhythm is regular with a normal S1 and S2. No murmurs, rubs, or gallops are appreciated. Peripheral pulses are brisk and symmetrical with trace pretibial pitting edema. Abdominal examination is benign. Dr Louis J. Dell'Italia:This patient presents with a 24-hour history of dyspnea progressing from symptoms with exertion to now occurring at rest. Probable causes for this presenting complaint often involve serious cardiopulmonary pathology. The history and physical examination is helpful in narrowing the differential and raises particular concern for acute pulmonary thromboembolism (PE). Certain risk factors increase suspicion for venous thrombosis in this patient, including obesity, hormone replacement therapy, and recent plane flight. However, air travel less than 6 hours is associated with a very low incidence of venous thromboembolism and therefore does not represent an identifiable risk factor for thrombosis.1 Rapid onset dyspnea at rest or exertion, as with this case, is the most common presenting symptom for acute PE. Currently the patient appears hemodynamically stable, although β-blockade may blunt a tachycardic response. Coupled with the history is an examination that is remarkable for an obvious elevation of the jugular venous pressure with clear lung fields, suggestive of right heart failure. Combined with sudden dyspnea and hypoxia, these findings strongly suggest the diagnosis of acute PE. It would be prudent to evaluate for deep vein thro...

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“…[2] Unfortunately, the rate of major bleeding complications with systemic thrombolysis has been reported to be as high as 20% in the clinical registries. [3,4] Recent major surgery (within the preceding three weeks) is one of the absolute contraindications for systemic thrombolysis. [2] Surgical embolectomy is another therapeutic option in patients with high-risk PE in whom thrombolysis is absolutely contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Treatment of pulmonary embolism with ultrasound-accelerated thrombolysis after coronary revascularization

Dönmez¹

2016

Turk Gogus Kalp Dama

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ÖZKalp cerrahisi sonrası pulmoner emboli nadir görülen, fakat ölümcül bir komplikasyondur. Bu yazıda, koroner revaskülarizasyon sonrası yüksek riskli pulmoner emboli gelişen, ultrasonla hızlandırılmış tromboliz ile tedavi edilen 46 yaşında bir erkek olgu sunuldu.Anah tar söz cük ler: Koroner arter baypas; pulmoner emboli; tromboliz. ABSTRACTPulmonary embolism after cardiac surgery is an uncommon, but fatal complication. Herein, we report a 46-year-old male case of high-risk pulmonary embolism after coronary revascularization who was treated with ultrasound-accelerated thrombolysis.

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Predictors of Major Hemorrhage Following Fibrinolysis for Acute Pulmonary Embolism

Cited by 142 publications

References 12 publications

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

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

Submassive Pulmonary Embolism

Treatment of pulmonary embolism with ultrasound-accelerated thrombolysis after coronary revascularization

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