The role of thrombolytic therapy in pulmonary embolism

Wang, Tzu‐Fei; Squizzato, Alessandro; Dentali, Francesco; Ageno, Walter

doi:10.1182/blood-2014-08-559278

Cited by 49 publications

(35 citation statements)

References 45 publications

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“…Some are concerned that procedural risks compound the inherent bleeding risk of the thrombolytic agents. 13 Others see CDT as an effective, minimally invasive, and safe treatment to prevent clinical deterioration and improve RV function. 9 The ideal candidate for CDT has central thrombus (main or lobar) and is stable enough to tolerate a prolonged infusion.…”

Section: Rationale Of Catheter-directed Thrombolysis For Submassive Pementioning

confidence: 99%

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Chiarello

Sista

2018

Semin intervent Radiol

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Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis. Three prospective trials have evaluated CDT for submassive PE; ULTIMA, SEATTLE II, and PERFECT. These trials provide evidence that CDT may improve radiographic efficacy endpoints in submassive PE with acceptable rates of major hemorrhage. However, the lack of clinical endpoints, long-term follow-up, and adequate sample size limit their generalizability. Future trials should be adequately powered and controlled so that the short- and long-term effectiveness and safety of CDT can be definitively determined.

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Section: Rationale Of Catheter-directed Thrombolysis For Submassive Pementioning

confidence: 99%

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Chiarello

Sista

2018

Semin intervent Radiol

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“…КУТ остаётся пока достаточно противоречивым методом, в качестве альтернативы системного назначения фибринолитического препарата [7]. Некоторые врачи обеспокоены, что риски, связанные с процедурой, могут суммироваться с присущим геморрагическим потенциалом тромболитических агентов [30]. Другие рассматривают КУТ как эффективный, минимально инвазивный и безопасный метод лечения для предотвращения клинического ухудшения состояния пациента и для улучшения функции ПЖ [27,31].…”

Section: тяжести легочной эмболииunclassified

The Role of Interventional Methods in Treatment of Pulmonary Embolism

et al. 2018

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The presented review concerns to current interventional methods of acute pulmonary embolism treatment. The article provides a rationale for catheter approaches, detailed description of patient selection and risk stratification including an estimation of thromboembolic burden, risk degree of acute pulmonary embolism, bleeding risk assessment, and patient-specific considerations. The review contains the up-to-date classification of pulmonary embolism on the basis of 30-day mortality assessment and estimation of disease outcome according to the conventional and simplified Pulmonary Embolism Severity Index. A special attention is paid to interventional methods peculiarly, in particular to catheter directed thrombolysis, rheolytic thrombectomy, thrombus fragmentation and aspiration. The results of studies concerning efficiency and safety of endovascular methods in treatment of pulmonary embolism patients are reported. It was emphasized importance of further investigation of various clinical aspects using these methods for obtaining of comprehensive information about treatment of the dangerous disease associated with significant morbidity and mortality.

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“…27 In a more recent systematic review that analyzed the six studies that included only patients with stable PE and clearly defined RV dysfunction, the mortality benefit lost statistical significance (1.5 vs. 2.9%; OR 0.55, 95% CI, 0.28-1.08). 28 In summary, although the risk of hemodynamic deterioration, recurrent PE, and death tends to be lower in patients with acute symptomatic PE that receive lytics, the high excess of major bleeding complications argues against the routine use of systemic thrombolysis in hemodynamically stable PE patients. Studies designed using updated methods of risk assessment may further elucidate the role of lytic therapy in patients with intermediate-risk PE.…”

Section: Full-dose Fibrinolysismentioning

confidence: 99%

Controversies in the Management of Life-Threatening Pulmonary Embolism

Marshall

Tapson

Jiménez

2015

Semin Respir Crit Care Med

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Patients with life-threatening pulmonary embolism (PE) offer clinicians a unique opportunity to intervene effectively on the patient's behalf. Hemodynamic status remains the most important short-term prognostic factor for patients with acute PE. Although the evidence is limited, the use of thrombolytic therapy is recommended for patients with acute symptomatic PE and associated hypotension or shock (i.e., high-risk PE) because these patients have a high short-term mortality risk (i.e., >15%) even when receiving anticoagulant treatment. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk. For hemodynamically stable patients with PE, the identification of a subgroup of patients with a risk of PE-related complications similar to patients with PE and cardiovascular instability (i.e., intermediate-risk group) may assist with decision making regarding therapy. Given the lack of clear mortality benefit and increased bleeding risk, guidelines do not recommend routine use of systemic thrombolysis for this subgroup of patients. Careful monitoring and rescue fibrinolysis for intermediate-risk PE patients who experience hemodynamic compromise or deterioration while receiving standard anticoagulant therapy can minimize deaths from PE. For patients with life-threatening PE at high risk of bleeding, clinicians might consider the use of low-dose thrombolytic therapy, catheter-directed thrombolysis, or surgical embolectomy, if they have access to the required expertise and resources. The evidence does not support the use of inferior vena cava filters in patients with life-threatening PE unless there is a contraindication to anticoagulation. Since various medical and surgical specialties offer different perspectives and expertise, a multidisciplinary approach to patients with intermediate- and high-risk PE might improve patient outcomes.

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The role of thrombolytic therapy in pulmonary embolism

Cited by 49 publications

References 45 publications

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

The Role of Interventional Methods in Treatment of Pulmonary Embolism

Controversies in the Management of Life-Threatening Pulmonary Embolism

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