Low‐dose systemic thrombolytic therapy for treatment of submassive pulmonary embolism: Clinical efficacy but attendant hemorrhagic risks

2018 ◽  
Author(s):  
Daniel P. Rothschild ◽  
James A. Goldstein ◽  
Terry R. Bowers
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Clinical Efficacy ◽  
Low Dose ◽  
Submassive Pulmonary Embolism ◽  
Systemic Thrombolytic Therapy

scholarly journals Systemic Thrombolytic Therapy for Massive and Submassive Pulmonary Embolism

2018 ◽  
Vol 33 (1) ◽  
pp. 74-89 ◽  
Author(s):  
Lauren A. Igneri ◽  
John M. Hammer
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
English Language ◽  
Right Ventricular Dysfunction ◽  
Hemodynamic Instability ◽  
Minor Bleeding ◽  
Increased Risk ◽  
Submassive Pulmonary Embolism ◽  
Systemic Thrombolytic Therapy

Objective: To critically evaluate the published literature assessing the safety and efficacy of thrombolytic therapy for massive and submassive pulmonary embolism (PE). Methods: A search of human trials in the English-language (September 2017) was conducted through the MEDLINE database using the following terms: PE, tissue plasminogen activator, tenecteplase, and alteplase. 67 unique articles were identified, of which 24 clinical trials discussing clinical outcomes related to administration of either intravenous tenecteplase or alteplase were included. Results: Thrombolytic therapy with anticoagulation significantly reduced mortality compared to anticoagulation alone in massive PE. In submassive PE, thrombolytics reduced the rate of right ventricular dysfunction and hemodynamic collapse; however, there is an increased risk of major and minor bleeding with no benefit on long-term functional outcomes. Conclusions: Patients with massive PE should receive thrombolytics when no major contraindications to therapy exist. Patients with submassive PE at highest risk for progression to hemodynamic instability should receive anticoagulation and be monitored for clinical deterioration. If an imminent risk of hemodynamic instability or cardiac arrest occurs, thrombolytics should be administered if no contraindications exist. Net mortality benefit and risk of bleeding must be considered when deciding to administer thrombolytic therapy in massive or submassive PE.

scholarly journals Letter to the Editor

2021 ◽  
Vol 20 (3) ◽  
pp. 234-234
Author(s):  
N Smallwood ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Recent Article ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Haemodynamic Stability ◽  
Submassive Pulmonary Embolism ◽  
Systemic Thrombolytic Therapy ◽  
Nice Guidance ◽  
Potential Benefits

I read the recent article by Apsey et al with interest, which recommended "the potential benefits of thrombolytic therapy in massive and submassive pulmonary embolism". This would appear to go against current NICE guidance which states "Do not offer pharmacological systemic thrombolytic therapy to people with PE and haemodynamic stability with or without right ventricular dysfunction". Both recent NICE and European pulmonary embolism (PE) guidance are clear that only high-risk PE (previously called 'massive') should routinely be thrombolysed.

scholarly journals Submassive Pulmonary Embolism: Current Perspectives and Future Directions

2021 ◽  
Vol 10 (15) ◽  
pp. 3383
Author(s):  
Phillip C. Nguyen ◽  
Hannah Stevens ◽  
Karlheinz Peter ◽  
James D. McFadyen
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Current Evidence ◽  
Conflicting Evidence ◽  
Submassive Pulmonary Embolism ◽  
High Risk Disease ◽  
Systemic Thrombolytic Therapy ◽  
Meta Analyses

Submassive pulmonary embolism (PE) lies on a spectrum of disease severity between standard and high-risk disease. By definition, patients with submassive PE have a worse outcome than the majority of those with standard-risk PE, who are hemodynamically stable and lack imaging or laboratory features of cardiac dysfunction. Systemic thrombolytic therapy has been proven to reduce mortality in patients with high-risk disease; however, its use in submassive PE has not demonstrated a clear benefit, with haemodynamic improvements being offset by excess bleeding. Furthermore, meta-analyses have been confusing, with conflicting results on overall survival and net gain. As such, significant interest remains in optimising thrombolysis, with recent efforts in catheter-based delivery as well as upcoming studies on reduced systemic dosing. Recently, long-term cardiorespiratory limitations following submassive PE have been described, termed post-PE syndrome. Studies on the ability of thrombolytic therapy to prevent this condition also present conflicting evidence. In this review, we aim to clarify the current evidence with respect to submassive PE management, and also to highlight shortcomings in current definitions and prognostic factors. Additionally, we discuss novel therapies currently in preclinical and early clinical trials that may improve outcomes in patients with submassive PE.

Efficacy and Safety of Low-Dose Systemic Fibrinolytic Therapy for Acute Submassive Pulmonary Embolism

2021 ◽  
Vol 14 (7) ◽  
pp. 809
Author(s):  
Ahmet Güner ◽  
Ezgi Gültekin Güner ◽  
Seda Karakurt ◽  
Macit Kalçık
Keyword(s):  
Pulmonary Embolism ◽  
Low Dose ◽  
Fibrinolytic Therapy ◽  
Efficacy And Safety ◽  
Submassive Pulmonary Embolism

scholarly journals Short-Term Mortality in Patients with Massive and Submassive Pulmonary Embolism Receiving Thrombolytic Therapy

2013 ◽  
Vol 84 (1) ◽  
pp. 62 ◽  
Author(s):  
Yun-Ju Cho ◽  
So-My Koo ◽  
Duk Won Bang ◽  
Ki-Up Kim ◽  
Soo-taek Uh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Short Term ◽  
Submassive Pulmonary Embolism ◽  
Short Term Mortality

Do patients with submassive pulmonary embolism benefit from thrombolytic therapy?

2016 ◽  
Vol 83 (12) ◽  
pp. 923-932
Author(s):  
Ali Ataya ◽  
Jessica Cope ◽  
Abbas Shahmohammadi ◽  
Hassan Alnuaimat
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Submassive Pulmonary Embolism

Systemic Thrombolytic Therapy and Catheter-Directed Fragmentation with Local Thrombolytic Therapy in Patients with Pulmonary Embolism

2017 ◽  
Vol 45 ◽  
pp. 98-105 ◽  
Author(s):  
Julia Klevanets ◽  
Vladimir Starodubtsev ◽  
Pavel Ignatenko ◽  
Olga Voroshilina ◽  
Pavel Ruzankin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Systemic Thrombolytic Therapy ◽  
Local Thrombolytic Therapy

scholarly journals Prolonged Chest Compressions during Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest due to Acute Pulmonary Embolism

2015 ◽  
Vol 42 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Carla Nobre ◽  
Boban Thomas ◽  
Luis Santos ◽  
João Tavares
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Cardiopulmonary Arrest ◽  
Hemodynamic Instability ◽  
Circulatory Support ◽  
Chest Compressions ◽  
Output State ◽  
Dismal Prognosis ◽  
Systemic Thrombolytic Therapy

Patients with hemodynamic collapse due to acute pulmonary embolism have a dismal prognosis if not treated rapidly. Therapeutic options include systemic thrombolytic therapy, rheolytic thrombectomy, and surgical embolectomy. However, the efficacy of thrombolytic therapy is diminished because the low-output state hinders effective delivery of the lytic agent to the thrombus. In the absence of any form of mechanical circulatory support, such as extracorporeal membrane oxygenation or cardiac surgery on site, we think that prolonged vigorous manual compressions might be the only way to support the circulation during the initial critical state, when thrombolytic therapy has been administered. We report the results of prolonged manual chest compressions (exceeding 30 minutes) on 6 patients who received tenecteplase in treatment of acute pulmonary embolism that induced in-hospital cardiopulmonary arrest. Four of 6 patients survived and were discharged from the hospital. In an era of increasing technologic complexity for patients with hemodynamic instability, we emphasize the importance of prolonged chest compressions, which can improve systemic perfusion, counteract the prothrombotic state associated with cardiopulmonary arrest, and give the lytic agent time to act.

Sign in / Sign up

Export Citation Format

Share Document