Risk factors for intracranial haemorrhage in patients with pulmonary embolism treated with thrombolytic therapy Development of the PE-CH Score

2017 ◽  
Vol 117 (02) ◽  
pp. 246-251 ◽  
Author(s):  
Saurav Chatterjee ◽  
Ido Weinberg ◽  
Robert W. Yeh ◽  
Anasua Chakraborty ◽  
Partha Sardar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Risk Score ◽  
Intracranial Haemorrhage ◽  
Validation Cohort ◽  
Bleeding Complications ◽  
Derivation Cohort ◽  
C Statistic ◽  
Potential Benefits ◽  
Score Model

SummaryPulmonary embolism (PE) is a major cause of morbidity and mortality world-wide, and the use of thrombolytic therapy has been associated with favourable clinical outcomes in certain patient subsets. These potential benefits are counterbalanced by the risk of bleeding complications, the most devastating of which is intracranial haemorrhage (ICH). We retrospectively evaluated 9703 patients from the 2003–2012 nationwide in-patient sample database (NIS) who received thrombolytics for PE. All patients with ICH during the PE hospitalisation were identified and a clinical risk score model was developed utilizing demographics and comorbidities. The dataset was divided 1:1 into derivation and validation cohorts. During 2003–2012, 176/9705 (1.8 %) patients with PE experienced ICH after thrombolytic use. Four independent prognostic factors were identified in a backward logistic regression model, and each was assigned a number of points proportional to its regression coefficient: pre-existing Peripheral vascular disease (1 point), age greater than 65 years (Elderly) (1 point), prior Cerebrovascular accident with residual deficit (5 points), and prior myocardial infarction (Heart attack) (1 point). In the derivation cohort, scores of 0, 1, 2 and ≥ 5 points were associated with ICH risks of 1.2 %, 1.9 %, 2.4 % and 17.8 %, respectively. Rates of ICH were similar in the validation cohort. The C-statistic for the risk score was 0.65 (0.61–0.70) in the derivation cohort and 0.66 (0.60–0.72) in the validation cohort. A novel risk score, derived from simple clinical historical elements was developed to predict ICH in PE patients treated with thrombolytics.Supplementary Material to this article is available online at www.thrombosis-online.com.

P1763Derivation and validation of a risk score to predict incomplete ST segment resolution in STEMI patients undergoing primary PCI: association with the benefit of Glycoprotein IIb-IIIa inhibitors Use

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Cornara ◽  
A Somaschini ◽  
M Ferlini ◽  
A Demarchi ◽  
A Mandurino Mirizzi ◽  
...  
Keyword(s):  
Risk Score ◽  
Survival Benefit ◽  
Validation Cohort ◽  
Univariate Analysis ◽  
University Hospital ◽  
Discrimination Power ◽  
Killip Class ◽  
Derivation Cohort ◽  
C Statistic ◽  
St Segment

Abstract Incomplete ST segment resolution (iSTR) is a well-known marker of poor outcome in patients undergoing primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI). The use of glycoprotein IIbIIIa inhibitors (GPIs) was suggested to be associated with a survival benefit in high-risk patients. A simple score to predict the risk for developing iSTR could help early identification of these patients and could allow a tailored use of pharmacological tools, such as GPIs. The aim of this study was to create and validate a numerical score to predict iSTR occurrence in STEMI patients undergoing pPCI and to assess its association with the potential benefit of GPIs use. We prospectively enrolled all STEMI patients undergoing pPCI in our University Hospital (2005–2017). iSTR was defined as a <70% resolution of initial ST segment shift in the lead with maximal ST deviation 60 min after reperfusion. Our population was randomly divided in two group: a derivation cohort (60%) and a validation cohort (40%). Potential predictors of iSTR were selected at univariate analysis and were then inserted in a multivariate binary stepwise-backward logistic regression. To create a risk score, numerical values were obtained considering the odds ratio of each independent predictor rounding to the nearest unit or half. A ROC curve with its c-statistic was then used to test the discrimination power of the score both in the derivation and in the validation cohort. Out of a total of 2959 patients, 1774 were included in the derivation: 480 (27%) of them presented iSTR. All-cause mortality at 30 days was significantly higher in patients with iSTR (OR 3.2, 95% CI 2.1–4.9, p<0.001). Anterior MI (OR 2.46, 95% CI 1.90–3.14, p<0.001, score 2.5), anemia at admission (OR 1.76, 95% CI 1.29–2.4, p<0.001, score 2), blood glucose >198 mg/dl at admission (OR 1.77, 95% CI 1.29–2.49, p<0.001, score 2), age >75 years (OR 1.54, 95% CI 1.15–2.10, p=0.004, score 1.5), female sex (OR 1.41, 95% CI 1.06–1.88, p=0.02, score 1.5) and Killip class >2 (OR 1.44, 95% CI 1.05–1.98, p=0.024, score 1.5) were identified as independent predictors of iSTR, creating a ISTR-score that ranged from 0 to 11. The validation cohort consisted in 1185 patients, with 31% showing iSTR. The c-statistic was 0.67 and 0.66 in the derivation and validation cohorts. Patients with score ≥4 versus <4 showed present a worst prognosys but a similar GPI use. Notably, GPIs were associated with a significant survival benefit among patients≥4 but not among patients <4 (Figure). The use of GPIs was not associated to any clinically relevant difference, the increase in bleeding risk appeared similar. A simple pre-procedural risk score may predict iSTR following pPPCI, allowing a rapid risk stratification and the identification of patients who show a favorable risk/benefit ratio for the use of more aggressive strategies such as GPIs. These findings deserve a prospective, randomized evaluation.

P6336Plasma proteomic profile predicts survival in heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Gui ◽  
R C She ◽  
J Li ◽  
H Sabbah ◽  
L K Williams ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Risk Score ◽  
Cox Regression ◽  
Validation Cohort ◽  
Predictive Score ◽  
Reduced Ejection Fraction ◽  
Derivation Cohort ◽  
C Statistic

Abstract Background Whether the plasma proteome can predict the course of heart failure (HF) and has incremental value to established predictors is uncertain. Methods Patients meeting Framingham HF criteria with history of reduced ejection fraction (n=1017) were prospectively enrolled in a registry and donated fasting blood samples. Plasma underwent analysis on the SOMAscan proteomic discovery platform, quantifying 4789 proteins using standard assay and quality controls. Patients were randomly divided into derivation (n=681) and validation (n=336) cohorts. We derived a proteomic risk score (PRS) in the derivation cohort using Lasso-penalized Cox regression and then tested it in the validation cohort. Both models were adjusted for an establish HF clinical risk score (MAGGIC) and NTproBNP. We assessed risk stratification improvement in the validation cohort by comparing models with and without PRS using the model C statistic, continuous net reclassification index (NRI), integrated discrimination index (IDI), and the median improvement in risk score (MIRS). Results Overall 47.5% of patients were African American, 35.2% were female, mean ejection fraction was 34.8%, and average age was 67.9 years. After median follow-up of 3.6 years, there were 296 deaths (194 in derivation and 102 in validation). Optimized modeling defined a 32 protein PRS (hazard ratio [HR] 2.33, p<2.00E-16) which was also statistically significant when tested in the validation cohort (PRS HR=1.19, p=4.87E-02) and showed some improvement in risk stratification (Table). Methods Variables Estimate 95% CI P Validation Testing MAGGIC 1.06 1.027, 1.092 2.84E-04 NTproBNP 1.84 1.430, 2.359 1.88E-06 PRS 1.19 1.001, 1.408 4.87E-02 Risk Stratification Assessment C-statistic improvement 0.012 −0.076, 0.101 8.30E-01 IDI 0.034 0.007, 0.095 <2.00E-16 Continuous-NRI 0.286 −0.062, 0.475 9.00E-02 Median Improvement in Risk Score 0.015 0.001, 0.078 2.00E-02 Conclusion A plasma multi-protein predictive score can improve risk stratification in HF patients on top of a validated clinical score and NTproBNP. Additional investigation is warranted to define mechanisms underlying individual proteins and explore proteomic clinical applications.

scholarly journals Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients

2009 ◽  
Vol 37 (3) ◽  
pp. 392-398 ◽  
Author(s):  
D. A. Story ◽  
M. Fink ◽  
K. Leslie ◽  
P. S. Myles ◽  
S.-J. Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Mortality Risk ◽  
Validation Cohort ◽  
Significant Risk ◽  
Postoperative Mortality ◽  
Risk Scores ◽  
Perioperative Mortality ◽  
Derivation Cohort ◽  
C Statistic

We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score. We included 1012 patients and the 30-day mortality was 6%. The three preoperative factors and risk scores were (“three A's”): 1) age, years: 70 to 79=1, 80 to 89=3, 90+=6; 2) ASA physical status: ASA I or II=0, ASA III=3, ASA IV=6, ASA V=15; and 3) preoperative albumin <30 g/l=2.5. The three postoperative factors and risk scores were (“three I's”) 1) unplanned intensive care unit admission =4.0; 2) systemic inflammation =3; and 3) acute renal impairment=2.5. Scores and mortality were: <5=1%, 5 to 9.5=7% and ≥10=26%. We also used a preliminary validation cohort of 256 patients from a regional hospital. The area under the receiver operating characteristic curve (C-statistic) for the derivation cohort was 0.80 (95% CI 0.74 to 0.86) similar to the validation C-statistic: 0.79 (95% CI 0.70 to 0.88), P=0.88. The Hosmer-Lemeshow test (P=0.35) indicated good calibration in the validation cohort. The Perioperative Mortality score is straightforward and may assist progressive risk assessment and management during the perioperative period. Risk associated with surgical complexity and urgency could be added to this baseline patient factor Perioperative Mortality score.

scholarly journals Development and validation of two SCORE-based cardiovascular risk prediction models for Eastern Europe: a multicohort study

2020 ◽  
Vol 41 (35) ◽  
pp. 3325-3333 ◽  
Author(s):  
Taavi Tillmann ◽  
Kristi Läll ◽  
Oliver Dukes ◽  
Giovanni Veronesi ◽  
Hynek Pikhart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prediction Models ◽  
Validation Cohort ◽  
European Countries ◽  
Eastern European ◽  
Risk Prediction Models ◽  
Derivation Cohort ◽  
Score Model ◽  
Eastern European Countries

Abstract Aims Cardiovascular disease (CVD) risk prediction models are used in Western European countries, but less so in Eastern European countries where rates of CVD can be two to four times higher. We recalibrated the SCORE prediction model for three Eastern European countries and evaluated the impact of adding seven behavioural and psychosocial risk factors to the model. Methods and results We developed and validated models using data from the prospective HAPIEE cohort study with 14 598 participants from Russia, Poland, and the Czech Republic (derivation cohort, median follow-up 7.2 years, 338 fatal CVD cases) and Estonian Biobank data with 4632 participants (validation cohort, median follow-up 8.3 years, 91 fatal CVD cases). The first model (recalibrated SCORE) used the same risk factors as in the SCORE model. The second model (HAPIEE SCORE) added education, employment, marital status, depression, body mass index, physical inactivity, and antihypertensive use. Discrimination of the original SCORE model (C-statistic 0.78 in the derivation and 0.83 in the validation cohorts) was improved in recalibrated SCORE (0.82 and 0.85) and HAPIEE SCORE (0.84 and 0.87) models. After dichotomizing risk at the clinically meaningful threshold of 5%, and when comparing the final HAPIEE SCORE model against the original SCORE model, the net reclassification improvement was 0.07 [95% confidence interval (CI) 0.02–0.11] in the derivation cohort and 0.14 (95% CI 0.04–0.25) in the validation cohort. Conclusion Our recalibrated SCORE may be more appropriate than the conventional SCORE for some Eastern European populations. The addition of seven quick, non-invasive, and cheap predictors further improved prediction accuracy.

Abstract 17048: Dederivation and Validation of a Simple Heart Risk Score in 608,544 Thai Adults: HCUR Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Parinya Chamnan ◽  
Weera Mahawanakul ◽  
Prasert Boongird ◽  
Wannee Nitiyanant ◽  
Wichai Aekplakorn ◽  
...  
Keyword(s):  
General Population ◽  
Risk Score ◽  
Retrospective Cohort ◽  
Validation Cohort ◽  
Information Criteria ◽  
Global Model ◽  
Derivation Cohort ◽  
Risk Equation ◽  
Risk Algorithm ◽  
Incident Cases

Introduction: Most heart risk prediction equations were developed in Western populations. These risk scores are likely to perform less well in Asian populations, who have different background risk. Hypothesis: This study aimed to develop and validate a new risk algorithm for estimating 5-year risk of developing coronary heart disease (CHD) in a large retrospective cohort of Thai general population. Methods: This retrospective cohort was derived from the linkage of 2006 health checks data with diagnostic information from electronic health records of 608,544 men and women aged 20 years and above residing in Ubon Ratchathani. It was randomly and evenly divided into the derivation and validation cohorts. An outcome of interest was first recorded diagnosis of CHD over a period of 6 years between January 2006 and December 2012. A Cox proportional hazards model was used to estimate effects of risk factors on CHD risk and to derive a risk equation in the derivation cohort. Measures of discrimination, global model fits and calibration were calculated in the validation cohort. Results: The derivation cohort comprised of 304,272 individuals, who contributed 1,757,369 person-years of follow-up and 1,272 incident cases of CHD, while the validation cohort comprised of 304,272 individuals (1,757,312 person-years), with 1,290 incident cases of stroke. The risk equation was 0.0580 x Age (years) + 0.5739 x Sex (Male=1) + 0.3850 x Hypertension (present=1) + 0.7080 x Diabetes (present=1) + 0.0386 x Body mass index (kg/m 2 ) + 0.2117 x Central obesity (present=1) - 0.1389 (if exercise 1-2 days/week) or -0.3975 (if exercise 3-5 days/week) or - 0.5598 (if exercise >5 days/week). The stroke risk equation had a reasonably good discriminatory ability in the validation cohort with the area under the receiver operating characteristic curve of 0.790 (95%CI 0.779-0.801). The risk equation had good global model fit as measured by Bayesian information criteria. The Gronnesby and Borgan test showed good calibration, with chi-square statistic of 809.45 (p<0.001). Conclusions: This simple heart risk score is the first risk algorithm to estimate the 5-year risk of CHD in a Thai general population. The risk score does not need laboratory tests and can therefore be used in clinical settings and by the public.

scholarly journals Analysis of the Cochrane Review: Thrombolysis for Acute Deep Vein Thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783.

2015 ◽  
Vol 28 (1) ◽  
pp. 12 ◽  
Author(s):  
Liliana Sousa Nanji ◽  
André Torres Cardoso ◽  
João Costa ◽  
António Vaz-Carneiro
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Thrombolytic Therapy ◽  
Bleeding Complications ◽  
Controlled Trials ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

<p>The standard treatment for acute deep vein thrombosis (DVT) targets to reduce immediate complications, however thrombolysis could reduce the long-term complications of post-thrombotic syndrome in the affected limb. This systematic review aimed to assess the effects of thrombolytic therapy and anticoagulation <em>versus </em>anticoagulation in people with deep vein thrombosis of the lower limb through the effects on pulmonary embolism, recurrent deep vein thrombosis, major bleeding, post-thrombotic complications, venous patency and venous function. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last search in April 2013) and CENTRAL (2013, Issue 4). A total of 17 randomised controlled trials (RCTs) and 1103 participants were included. In the experimental group receiving thrombolysis, complete clot lysis occurred more frequently and there was greater improvement in venous patency. The incidence of post-thrombotic syndrome decreased by a 1/3 and venous ulcers were less frequent. There were more bleeding complications and 3 strokes occurred in less recent studies, yet there seemed to be no significant effect on mortality. Data on the occurrence of pulmonary embolism and recurrent deep vein thrombosis were inconclusive. There are advantages to thrombolysis, yet the application of rigorous criteria is warranted to reduce bleeding complications. Catheter-directed thrombolysis is the current preferred method, as opposed to systemic thrombolysis in the past, and other studies comparing these procedures show that results are similar.</p><p><strong>Keywords:</strong> Randomized Controlled Trials as Topic; Thrombolytic Therapy; Venous Thrombosis.</p>

Derivation and Validation of a Prediction Tool for Venous Thromboembolism: A VERITY Registry Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 697-697 ◽  
Author(s):  
Roopen Arya ◽  
Shankaranarayana Paneesha ◽  
Aidan McManus ◽  
Nick Parsons ◽  
Nicholas Scriven ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Risk Score ◽  
Validation Cohort ◽  
Accurate Estimation ◽  
Parameter Estimates ◽  
Model Parameters ◽  
Derivation Cohort ◽  
Hormonal Factor ◽  
Electronic Alerts

Abstract Accurate estimation of risk for venous thromboembolism (VTE) may help clinicians assess prophylaxis needs. Only empirical algorithms and risk scores have been described; an empirical risk score (‘Kucher’) based on 8 VTE risk factors (cancer, prior VTE, hypercoagulability, surgery, age>75 yrs, BMI>29, bed rest, hormonal factor) using electronic alerts improved hospitalized patient outcome (NEJM2005;352:969–77). We wished to develop a multivariate regression model for VTE risk, based on Kucher, and validate its performance. The initial derivation cohort consisted of patients enrolled in ‘VERITY’, a multicentre VTE treatment registry for whom the endpoint of VTE and all 8 risk factors were known. Initial univariate analysis (n=5928; 32.4% with diagnosis of VTE) suggested VTE risk was not accounted for by the 8 factors; an additional 3 were added (leg paralysis, smoking, IV drug use [IVD]). The final derivation cohort was 5241 patients (32.0% with VTE) with complete risk data. The validation cohort (n=915) was derived from a database of 928 consecutively enrolled patients at a single DVT clinic. Model parameters were estimated using the statistical package ‘R’ using a stepwise selection procedure to choose the optimal number of main effects and pair-wise interactions. This showed that advanced age (estimated odds ratio [OR]=2.8, p<0.001); inpatient (OR=3.0, p<0.001); surgery (OR=3.1, p<0.001); prior VTE (OR=2.9, p<0.001); leg paralysis (OR=3.8, p<0.001); cancer (OR=5.3, p<0.001); IVD (OR=14.3, p<0.001); smoking (OR=1.2, p=0.009); and thrombophilia (OR=2.8; p<0.001) increased the risk of VTE. Obesity (OR=0.7; p<0.001) increased the VTE risk only in patients with a hormonal factor (OR=2.0, p=0.007). Backward stepwise regression showed prior VTE as the most important factor followed by cancer, IVD, surgery, inpatient, age, leg paralysis, hormonal factor, obesity, thrombophilia and smoking. Expressing the parameter estimates in terms of probabilities defines a risk score model for VTE. Using the model, the receiver operating characteristic (ROC) curve (see figure) area under the curve (AUC) was estimated as 0.720 (95% CI, 0.705–0.735) for the model (dashed line), indicating a good diagnostic test significantly better (p<0.001) than Kucher (AUC=0.617, 95% CI, 0.599–0.634)(solid line). For the validation cohort, AUC was estimated as 0.678 (95% CI, 0.635–0.721) for the model, which was not significantly different from AUC for the full dataset used for model development, and was 0.587 (95% CI, 0.542–0.632) for Kucher. This model to predict individual patient risk of VTE may contribute to decision making regarding prophylaxis in clinical practice. Figure Figure

scholarly journals Prediction of Graft Survival Post-liver Transplantation by L-GrAFT Risk Score Model, EASE Score, MEAF Scoring, and EAD

2021 ◽  
Vol 8 ◽  
Author(s):  
Shirui Chen ◽  
Tielong Wang ◽  
Tao Luo ◽  
Shujiao He ◽  
Changjun Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
High Risk ◽  
Graft Survival ◽  
Risk Score ◽  
Risk Group ◽  
High Risk Group ◽  
Liver Graft ◽  
C Statistic ◽  
Score Model

Background: Early allograft dysfunction (EAD) is correlated with poor patient or graft survival in liver transplantation. However, the power of distinct definitions of EAD in prediction of graft survival is unclear.Methods: This retrospective, single-center study reviewed data of 677 recipients undergoing orthotopic liver transplant between July 2015 and June 2020. The following EAD definitions were compared: liver graft assessment following transplantation (L-GrAFT) risk score model, early allograft failure simplified estimation score (EASE), model for early allograft function (MEAF) scoring, and Olthoff criteria. Risk factors for L-GrAFT7 high risk group were evaluated with univariate and multivariable logistic regression analysis.Results: L-GrAFT7 had a satisfied C-statistic of 0.87 in predicting a 3-month graft survival which significantly outperformed MEAF (C-statistic = 0.78, P = 0.01) and EAD (C-statistic = 0.75, P &lt; 0.001), respectively. L-GrAFT10, EASE was similar to L-GrAFT7, and they had no statistical significance in predicting survival. Laboratory model for end-stage liver disease score and cold ischemia time are risk factors of L-GrAFT7 high-risk group.Conclusion: L-GrAFT7 risk score is capable for better predicting the 3-month graft survival than the MEAF and EAD in a Chinese cohort, which might standardize assessment of early graft function and serve as a surrogate endpoint in clinical trial.

Streptokinase and Urokinase in the Treatment of Pulmonary Thromboemboli

1976 ◽  
Vol 35 (01) ◽  
pp. 057-069 ◽  
Author(s):  
William R Bell
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Phase I ◽  
Phase Ii ◽  
Clinical History ◽  
Pulmonary Angiography ◽  
Lung Perfusion ◽  
Bleeding Complications ◽  
Significant Difference ◽  
Cardiopulmonary Hemodynamics

SummaryIn Phase I of this study of 160 patients with pulmonary embolism, it was demonstrated that 12 hours of urokinase accelerated the resolution of pulmonary thromboemboli compared to heparin alone. Phase II compared 12 hours of urokinase, 24 hours of urokinase and 24 hours of streptokinase in 167 patients. All patients had a clinical history and angiographic diagnosis of pulmonary embolism. Patients were randomly allocated to treatment. All physicians making patient observations were unaware of drug assignment.Resolution of the thromboembolism 24–30 hours after therapy had been instituted was determined by pulmonary angiography, lung perfusion scans and cardiopulmonary hemodynamics. Twenty-four hours of urokinase did not demonstrate greater clot resolution than 12 hours of urokinase. Twenty-four hours of urokinase resulted in greater improvement than streptokinase in lung perfusion scans, but not in angiograms. In patients with massive embolism, this difference was statistically significant. Hemodynamic differences varied.Bleeding complications and morbidity due to allergic reactions with streptokinase and urokinase were minimal. There was no statistically significant difference in mortality in the three treatment groups.From the Phase I and Phase II data it is reasonable to conclude that all three regimens of thrombolytic therapy are more effective than heparin alone in accelerating resolution of pulmonary emboli. Thrombolytic therapy offers the clinician an alternative to pulmonary embolectomy.

Massive pulmonary embolism in a young boy with T-cell leukaemia

2014 ◽  
Vol 34 (03) ◽  
pp. 233-236
Author(s):  
C. Martin ◽  
F. Alt ◽  
A. Wingerter ◽  
G. Staatz ◽  
H. Schinzel ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Bleeding Complications ◽  
Cell Leukaemia ◽  
Malignant Diseases ◽  
Systemic Thrombolytic Therapy ◽  
Tissue Plasminogen

SummaryAcute pulmonary embolism (PE) is a serious complication in association with malignant diseases. We describe the successful treatment of PE applying a systemic thrombolytic therapy in a 4-year-old boy with acute lymphoblastic leukaemia.The thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) 0.1 mg/ kg bodyweight per hour for six hours was continued for six days without important side effects. In particular no bleeding complications were observed. Computed tomography with contrast revealed a remarkable regression of the central PE. Without further delays the chemotherapy was resumed.

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