Thrombolytic therapy for pulmonary embolism

Qin, Hao; Dong, Bi Rong; Yue, Jirong; Wu, Taixiang; Liu, Guan J

doi:10.1002/14651858.cd004437.pub4

Cited by 32 publications

(28 citation statements)

References 71 publications

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“…Logistic regression analysis showed a beneficial effect of thrombolysis. This finding is similar to previously reported data [20]. There is good evidence on superiority of thrombolysis to heparin alone to accelerate lysis of emboli and restore hemodynamics and RV function [20, 21].…”

Section: Discussionsupporting

confidence: 92%

“…This finding is similar to previously reported data [20]. There is good evidence on superiority of thrombolysis to heparin alone to accelerate lysis of emboli and restore hemodynamics and RV function [20, 21]. Most patients respond favorably to thrombolysis, as judged by clinical and echocardiographic improvement within 36 hours [22].…”

Section: Discussionsupporting

confidence: 89%

“…Overall rate for major bleeding is 10% [21]. In this study, although the thrombolysis rate is higher than previously reported, the complication rate was relatively low [9, 20]. We think that the main reason for low complication rate is multidisciplinary assessment for indications and possible contraindications for thrombolysis.…”

Section: Discussionmentioning

confidence: 59%

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Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Ergan

Ergün

Çalışkan

et al. 2016

Canadian Respiratory Journal

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Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; p = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

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Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Ergan

Ergün

Çalışkan

et al. 2016

Canadian Respiratory Journal

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“…Another parameter that can be used for resuming unfractionated heparin is serum fibrinogen concentration, which should be above 100 mg/dL. 15,16,44 …”

Section: Systemic Fibrinolysis Doses In Ptementioning

confidence: 99%

“…12,13 As a result, current consensus statements on management of PTE are clear and objective in stating that the only precise indication for using SFT is in patients with HI. 3,14,15 The ninth consensus of the American College of Chest Physicians (ACCP), in 2012, suggested that SFT should only be used in the absence of HI in severe PTE with RV failure and even this recommendation was based on a very weak evidence level (2C) and was subject to case-by-case assessment of risks and benefits. 14 A recently-published study described experience with use of SFT in 20% of American hospitals.…”

Section: Introductionmentioning

confidence: 99%

Terapia fibrinolítica sistêmica no tromboembolismo pulmonar

Ceresetto

Marques

2017

J. vasc. bras.

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Pulmonary thromboembolism remains a major therapeutic challenge for specialists and, despite investment and the consequent developments in diagnosis, prophylaxis, and treatment, the condition is still the leading cause of avoidable deaths in hospital settings. There is still great uncertainty with relation to the profile of patients who will actually benefit from systemic fibrinolytic treatment, without being exposed to serious risk of bleeding. There are tools that can help to identify patients who will benefit, including risk stratification and estimation of the prognosis of the event, with clinical scores for right ventricular failure, markers of right ventricular dysfunction and dilatation, and thrombotic mass assessment, whether alone or in combination. The only points of consensus with relation to fibrinolytic therapy for treatment of pulmonary thromboembolism are as follows: it should not be routinely indicated, none of the scores or markers alone should be used to justify its use, and patients with hemodynamic instability are the most likely to benefit. Furthermore, each case should be evaluated for risk of bleeding, especially central nervous system bleeding.Keywords: fibrinolytics; pulmonary embolism; hemorrhage. ResumoO tromboembolismo pulmonar permanece como um grande desafio terapêutico para os médicos especialistas, pois, apesar de todo investimento e desenvolvimento em seu diagnóstico, profilaxia e tratamento, essa condição continua sendo a principal causa de morte evitável em ambiente hospitalar. Ainda restam muitas dúvidas em relação a qual perfil de paciente vai se beneficiar de fato da terapia fibrinolítica sistêmica, sem ficar exposto a um grande risco de sangramento. A estratificação de risco e a avaliação do prognóstico do evento, através de escores clínicos de insuficiência ventricular direita, marcadores de dilatação e disfunção do ventrículo direito e avaliação da massa trombótica, associados ou de forma isolada, são ferramentas que podem auxiliar na identificação do paciente que irá se beneficiar dessa terapia. Os únicos consensos em relação à terapia fibrinolítica no tratamento do tromboembolismo pulmonar são: não deve ser indicada de forma rotineira; nenhum dos escores ou marcadores, isoladamente, devem justificar seu uso; e os pacientes com instabilidade hemodinâmica são os mais beneficiados. Além disto, deve-se avaliar cada caso em relação ao risco de sangramento, especialmente no sistema nervoso central.Palavras-chave: fibrinolíticos; embolia pulmonar; hemorragia.

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Venous Thromboembolism

Tritschler

Kraaijpoel

Gal

et al. 2018

JAMA

263

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enous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease. The estimated incidence of a first acute VTE is 0.7 to 1.4 per 1000 person-years and is mostly observed in patients older than 55 years. [1][2][3][4] While the incidence of DVT has remained constant over time, 5 hospital admissions for PE in the United States more than doubled over the last decades, 6 partly because of widespread use of sensitive imaging techniques detecting smaller, potentially insignificant emboli. 7 Even though the in-hospital case-fatality rate of PE has decreased in the United States between 1999 and 2008, 8 about 30% of patients with PE die within the first year after diagnosis. 4 The socioeconomic effect of VTE is significant, with estimated annual costs ranging from $13.5 billion to $27.2 billion in the United States. 9Clinical signs and symptoms of DVT include unilateral leg pain, redness, swelling, edema, warmth, and tenderness. Pulmonary embolism may present with dyspnea, chest pain, hemoptysis, syncope, tachycardia, and hypotension. The clinical presentation of VTE is often not specific, and DVT can be indistinguishable from cellulitis, hematoma, superficial thrombophlebitis, and congestive heart failure. Pulmonary embolism presents similarly to myocardial infarction, congestive heart failure, and other diseases. Consequently, imaging is needed to confirm the diagnosis of VTE. The diagnosis of VTE is made in a sequence of steps including assessment of the pretest probability, followed by D-dimer testing and imaging as appropriate (Figure 1). When VTE is diagnosed, immediate initiation of anticoagulant therapy is imperative. The choice among different anticoagulant agents and the duration of treatment are based IMPORTANCE Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease.OBJECTIVE To summarize the advances in diagnosis and treatment of VTE of the past 5 years.EVIDENCE REVIEW A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using broad terms for diagnosis and treatment of VTE to find systematic reviews and meta-analyses, randomized trials, and prospective cohort studies published between January 1, 2013, and July 31, 2018. The 10th edition of the American College of Chest Physicians Antithrombotic Therapy Guidelines was screened to identify additional studies. Screening of titles, abstracts, and, subsequently, full-text articles was performed in duplicate, as well as data extraction and risk-of-bias assessment of the included articles.FINDINGS Thirty-two articles were included in this review. The application of an age-adjusted D-dimer threshold in patients with suspected PE has increased the number of patients in whom imaging can be withheld. The Pulmonary Embolism Rule-Out Criteria safely exclude PE when the pretest probability is low. The introduction of direct oral anticoagulants has allowed for a simpli...

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Thrombolytic therapy for pulmonary embolism

Cited by 32 publications

References 71 publications

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Terapia fibrinolítica sistêmica no tromboembolismo pulmonar

Venous Thromboembolism

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