Thrombolysis in pulmonary embolism: are we under-using it?

Loebinger, M.R.; Bradley, Jennifer

doi:10.1093/qjmed/hch069

Cited by 9 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The two-hour period was chosen to mimic the time course of thrombolysis in treating a massive pulmonary embolism (30,31). The ADC and T 2 maps acquired during the thrombolysis enabled the selection of limiting ADC and T 2 values, by which the regions of the clot could be divided into two parts: the efficiently lysable part and the poorly lysable part.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the ADC and T ₂ mapping in an assessment of blood-clot lysability

2009

View full text Add to dashboard Cite

The structural characteristics of blood clots are associated with their susceptibility to thrombolysis. As their morphology can be characterized by MRI, several attempts have been made to link the lysability of blood clots with their MRI properties; however, so far no study has associated a clot's lysability with the diffusion properties of the water in the clot. The apparent diffusion coefficient (ADC) is highly sensitive to changes in serum mobility and may be used to distinguish between the non-retracted and the fully retracted regions of the blood clot. Therefore, the ADC may be a suitable, or even a better, marker for an assessment of the clot's retraction and consequently for its lysability than the relaxation time T(2). The purpose of this study was to evaluate whether it is possible to predict the outcome of clot thrombolysis by ADC mapping prior to treatment. After two hours of thrombolysis using a recombinant tissue plasminogen activator in plasma, whole-blood clots were efficiently dissolved in regions with ADC >or= 0.8 x 10(-9) m(2)/s or T(2) >or= 130 ms, whereas dissolution was poor and prolonged in regions with ADC < 0.8 x 10(-9) m(2)/s or T(2) < 130 ms. An analysis based on a comparison between the initial and final ADC and T(2) maps after two hours of thrombolysis showed that the ADC can more accurately detect the different grades of clot retraction than T(2) and predict the regions of a clot that are resistant to thrombolysis. Therefore, the ADC could be used as an efficient prognostic marker for the outcome of thrombolysis. However, in vivo studies are needed to test this idea.

show abstract

Section: Discussionmentioning

confidence: 99%

A comparison of the ADC and T ₂ mapping in an assessment of blood-clot lysability

2009

View full text Add to dashboard Cite

show abstract

“… 12 Markers such as D-dimer concentration are associated with deleterious patient trajectory and increased incidence of mortality. 9 While COVID-19 is typically associated with pneumonia, a multi-system inflammatory disorder and deregulated coagulation are at play leading to poor outcomes in those worst affected. 13 …”

Section: Discussionmentioning

confidence: 99%

Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis

2020

View full text Add to dashboard Cite

COVID-19 is the infectious disease caused by a recently discovered SARS-CoV-2. Following an initial outbreak in December 2019 in Wuhan, China, the virus has spread globally culminating in the WHO declaring a pandemic on 11 March 2020. We present the case of a patient with an initial presentation of COVID-19 pneumonitis requiring mechanical ventilation for nearly 2 weeks and total admission time of 3 weeks. She was given prophylactic dose anticoagulation according to hospital protocol during this time. Following a week at home, she was readmitted with acute massive pulmonary embolism with severe respiratory and cardiac failure, representing the first such case in the literature.

show abstract

“…While some authors suggest that patients must be stratified with echocardiography and thrombolysed when normotensive with moderate or severe RVD [26,39], others are emphasize the lack of large randomized clinical trials determining end points, the risk of severe hemorrhage associated with thrombolysis and the fact that patients can only improve their hemodynamic condition with heparin treatment to contraindicate thrombolysis [38]. While some authors suggest that patients must be stratified with echocardiography and thrombolysed when normotensive with moderate or severe RVD [26,39], others are emphasize the lack of large randomized clinical trials determining end points, the risk of severe hemorrhage associated with thrombolysis and the fact that patients can only improve their hemodynamic condition with heparin treatment to contraindicate thrombolysis [38].…”

Section: Comparison Between Heparin and Throm-bolysis In Pte With Rvdmentioning

confidence: 99%

Treatment of Pulmonary Thromboembolism in Patients with Systemic Blood Pressure Stability and Right Ventricular Dysfunction

Yoo¹,

Rodrigues²,

Queluz

2008

CRMR

View full text Add to dashboard Cite

Pulmonary thromboembolism (PTE) ranges from incidental, clinically unimportant thromboembolism to massive embolism with sudden death. Its treatment is well established in two groups of patients: heparin for those with normal systemic blood pressure without right ventricular dysfunction (RVD) and thrombolysis for those with RVD and circulatory shock. In an intermediate group of patients with systemic blood pressure stability combined with RVD, which is usually associated with worse outcome, the treatment is controversial. There are authors who strongly suggest thrombolysis while others contraindicate this procedure and recommend anticoagulation with heparin. This is a narrative review that includes clinical trials comparing thrombolysis and heparin for the treatment of PTE patients with systemic blood pressure stability and RVD published since 1973.The results show that there are only four trials on this subject with less than 500 patients. Many PTE patients with systemic blood pressure stability and RVD might benefit from thrombolysis but, on the other hand, the risk for hemorrhagic events may be increased. Large randomized clinical trials are required to clarify this.

show abstract

Thrombolysis in pulmonary embolism: are we under-using it?

Cited by 9 publications

References 23 publications

A comparison of the ADC and T ₂ mapping in an assessment of blood-clot lysability

A comparison of the ADC and T ₂ mapping in an assessment of blood-clot lysability

Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis

Treatment of Pulmonary Thromboembolism in Patients with Systemic Blood Pressure Stability and Right Ventricular Dysfunction

Contact Info

Product

Resources

About

Thrombolysis in pulmonary embolism: are we under-using it?

Cited by 9 publications

References 23 publications

A comparison of the ADC and T 2 mapping in an assessment of blood-clot lysability

A comparison of the ADC and T 2 mapping in an assessment of blood-clot lysability

Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis

Treatment of Pulmonary Thromboembolism in Patients with Systemic Blood Pressure Stability and Right Ventricular Dysfunction

Contact Info

Product

Resources

About

A comparison of the ADC and T ₂ mapping in an assessment of blood-clot lysability

A comparison of the ADC and T ₂ mapping in an assessment of blood-clot lysability