scholarly journals A systematic review for the role of systemic thrombolysis in intermediate-risk (submassive) pulmonary embolism

2020 ◽  
Vol 2019 (2) ◽  
Author(s):  
Mohamed Ahmed Seif
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Intermediate Risk ◽  
Systemic Thrombolysis ◽  
Submassive Pulmonary Embolism

scholarly journals Low-dose thrombolysis for submassive pulmonary embolism

2021 ◽  
pp. jim-2021-001816
Author(s):  
Emine Serap Yilmaz ◽  
Oğuz Uzun
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Left Ventricular ◽  
Tissue Type ◽  
Bleeding Complications ◽  
Intermediate Risk ◽  
Risk Of Bleeding ◽  
Submassive Pulmonary Embolism ◽  
Half Dose

The role of thrombolysis in submassive pulmonary embolism (PE) is controversial due to the high risk of hemorrhage. This study aimed to evaluate the role of half-dose tissue-type plasminogen activator (rt-PA) in preventing death/hemodynamic decompensation in submassive (intermediate-risk) PE without increasing the risk of bleeding. In a prospective, non-randomized, open-label, single-center trial, we compared 50 mg rt-PA plus low molecular weight heparin (LMWH) with LMWH in submassive (intermediate-risk) PE. Eligible cases had confirmed pulmonary hypertension on echocardiography, and/or right ventricular cavity expansion and/or interventricular septal deviation on echocardiography, and/or right to left ventricular ratio equal to or greater than 0.9 mm on CT angiography. The primary outcome was death or hemodynamic decompensation within 7 and 30 days after treatment was given. The primary safety outcome was major extracranial bleeding or hemorrhagic stroke within 7 days. Seventy-six patients were included in the study. Total death/hemodynamic decompensation in the first 7 and 30 days was significantly less in the half-dose rt-PA group than in the LMWH group (p=0.028 and p=0.009, respectively). No significant differences were found between the two groups in terms of recurrent embolism and pulmonary hypertension at 6-month follow-up (p=1.000 and p=0.778). There was no intracranial hemorrhage in any of the patients. There were no statistically significant differences between the two groups in terms of major or minor bleeding complications. This trial showed half-dose rt-PA treatment in submassive (intermediate-risk) PE prevented death/hemodynamic decompensation in the first 7-day and 30-day period compared with LMWH treatment without increasing the risk of bleeding.

Systematic Review: The Role of Thrombolysis in Intermediate-Risk Pulmonary Embolism

2019 ◽  
Vol 57 (4) ◽  
pp. 517-522
Author(s):  
David Pillus ◽  
Eric Bruno ◽  
David Farcy ◽  
Gary M. Vilke ◽  
Richard Childers
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Intermediate Risk

scholarly journals Potential role of systemic thrombolysis in acute submassive intermediate risk pulmonary embolism: review and future perspectives

2016 ◽  
Vol 10 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Mohamed Teleb ◽  
Mateo Porres-Aguilar ◽  
Javier E. Anaya-Ayala ◽  
Carlos Rodriguez-Castro ◽  
Mateo Porres-Muñoz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Potential Role ◽  
Intermediate Risk ◽  
Future Perspectives ◽  
Systemic Thrombolysis

Advanced Management Options for Massive and Submassive Pulmonary Embolism

2016 ◽  
Vol 10 (1) ◽  
pp. 30 ◽  
Author(s):  
Sonika Malik ◽  
◽  
Anju Bhardwaj ◽  
Matthew Eisen ◽  
Sanjay Gandhi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Vena Cava ◽  
Right Ventricular Dysfunction ◽  
Hemodynamic Instability ◽  
Adverse Outcomes ◽  
Intermediate Risk ◽  
Management Options ◽  
Vena Cava Filters ◽  
Submassive Pulmonary Embolism ◽  
Risk Patients

Pulmonary embolism (PE) is an important cause of morbidity and mortality and presents with significant diagnostic and therapeutic challenges. Clinical presentation ranges from mild, nonspecific symptoms to syncope, shock, and sudden death. Patients with hemodynamic instability and/ or signs of right ventricular dysfunction are at high risk for adverse outcomes and may benefit from aggressive therapy and support. Therapeutic anticoagulation is indicated in all patients in the absence of contraindications. Thrombolysis should be strongly considered in selected high- and intermediate-risk patients, either by systemic infusion or percutaneous catheter-directed therapy. Other therapeutic modalities, such as vena cava filters and surgical embolectomy, are options for patients who fail or cannot tolerate anticoagulation and/or thrombolysis. This article reviews the assessment and advanced management options for acute PE with focus on high- and intermediate-risk patients.

scholarly journals The net benefit of thrombolysis in the management of intermediate risk pulmonary embolism: Systematic review and meta‐analysis

eJHaem ◽  
2020 ◽  
Vol 1 (2) ◽  
pp. 457-466
Author(s):  
Pedro E. Alcedo ◽  
Herney Andrés García‐Perdomo ◽  
Cristhiam M. Rojas‐Hernandez
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Meta Analysis ◽  
Intermediate Risk ◽  
Net Benefit

scholarly journals Catheter-directed therapy for submassive pulmonary embolism after unsuccessful systemic thrombolysis

2017 ◽  
Vol 8 (1) ◽  
pp. 204589321773626 ◽  
Author(s):  
Chang Dong ◽  
Shufen Jiang ◽  
Donghua Ji ◽  
Yingqun Ji ◽  
Zhonghe Zhang
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Systemic Thrombolysis ◽  
Submassive Pulmonary Embolism ◽  
Life Threatening

Catheter-directed therapy (CDT) has emerged as an important treatment for pulmonary embolism (PE). We present a patient with life-threatening submassive PE with transient hypotension, progressive right ventricular dysfunction, and respiratory failure who failed anticoagulation and had little improvement with systemic thrombolysis, but responded well to catheter-directed therapy.

scholarly journals Thrombolytic therapy for pulmonary embolism: lessons from recent clinical trials

2015 ◽  
Vol 3 (4) ◽  
Author(s):  
Lexin Wang
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Clinical Studies ◽  
Massive Pulmonary Embolism ◽  
Common Disease ◽  
Thrombolytic Treatment ◽  
Normal Blood Pressure ◽  
Life Saving ◽  
Submassive Pulmonary Embolism

Pulmonary embolism is a common disease that is associated with significant mobility and mortality. Thrombolysis is potentially life saving when used in conjunction with anticoagulant therapy. Indications for thrombolysis for pulmonary embolism are not well defined. In patients with acute massive pulmonary embolism and hypotension, thrombolytic therapy offers some benefits in terms of mortality reduction. The use of thrombolysis in patients with stable haemodynamics has been controversial for more than two decades. Recent clinical studies have indicated that thrombolytic treatment in conjunction with heparin in patients with submassive pulmonary embolism and normal blood pressure can prevent deterioration of the disease and diminish the need for more intensive therapies during hospitalisation. The role of prehospital thrombolytic therapy for acute pulmonary embolism is unclear and further clinical studies are warranted.

Intrapulmonary Artery Thrombolysis in Acute Pulmonary Embolism: Case Series from King Chulalongkorn Memorial Hospital Experience

2021 ◽  
Vol 104 (8) ◽  
pp. 1376-1380
Keyword(s):  
Pulmonary Embolism ◽  
Plasminogen Activator ◽  
Acute Pulmonary Embolism ◽  
Case Series ◽  
Systemic Thrombolysis ◽  
Tissue Plasminogen ◽  
Surgical Embolectomy ◽  
Surgical Thrombectomy ◽  
Acute Pe

Acute pulmonary embolism (PE) is a life-threatening condition. In patient who has contraindication for systemic thrombolysis and inappropriate for surgical embolectomy, there is a role of catheter interventions. However, the data are limited. The aim of the present report was to assess a role of intrapulmonary artery thrombolysis bolus in acute PE. A retrospective review of the use of intrapulmonary artery thrombolysis in acute PE. The data were collected from 14 patients with massive or submassive PE who had contraindication or inappropriate for systemic thrombolysis and unsuitable for surgical embolectomy. After intrapulmonary thrombolysis was given, patients were followed clinically and hemodynamically until discharged and after 1 month. Pulmonary pressure was collected at pre and post intervention. Of the 14 patients (age 59±19 years, 78.6% female), 86% were diagnosed as submassive PE. Mean dose of tissue plasminogen activator (rt-PA) was 28±14 mg given as bolus and continuous infusion (19±10 hours). One patient died after completion of intrapulmonary infusion rt-PA at day 90, which did not relate to PE and the treatment. After intervention, mean PA pressure was significantly reduced from 32.3±6.0 to 21.0±4.3 mmHg (p<0.001). Three patients (21%) had minor bleeding (hematoma at access site). The present case series showed that intrapulmonary infusion of rt-PA was effective and safe in patient with massive and submassive PE who had contraindication or inappropriate to systemic thrombolysis or inoperable surgical thrombectomy. Keywords: Acute pulmonary embolism; Intrapulmonary thrombolysis; Tissue plasminogen activator; Surgical thrombectomy

Sign in / Sign up

Export Citation Format

Share Document