Thrombolysis for Venous Thromboembolism During Pregnancy: A Literature Review

Background: Pregnancy is a hypercoagulable state, conferring an increased risk of venous thromboembolism (VTE). However, treatment algorithms for deep venous thrombosis and pulmonary embolism are based on studies of nonpregnant patients. Methods: A literature review of cases in which thrombolysis was used for the treatment of VTE during pregnancy was conducted using the PubMed (National Institutes of Health) database. Results: A PubMed database search of English language articles for reports of thrombolysis for the treatment of VTE in pregnancy identified 215 cases, including 183 cases of systemic thrombolysis, 19 cases of catheter-directed thrombolysis, and 13 cases of mechanical thrombectomy. For systemic thrombolysis, the maternal complication rate was 4.40% and the fetal complication rate was 1.65%. For catheter-directed thrombolysis, the maternal complication rate was 14.75% and the fetal complication rate was 5.2%. In cases of mechanical thrombectomy, there were no reported maternal or fetal complications. Conclusions: Although conservative strategies are preferred in pregnancy, thrombolysis is an adjunct for limb or life-threatening VTE. Review of past reports suggests low rates of maternal and fetal complications following systemic thrombolysis and mechanical thrombectomy but higher rates of complications after catheter-directed thrombolysis in the treatment of VTE during pregnancy.

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Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/171828 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

A. D. Herrera-Martínez ◽

R. Bahamondes-Opazo ◽

R. Palomares-Ortega ◽

C. Muñoz-Jiménez ◽

M. A. Gálvez-Moreno ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Early Diagnosis ◽

Literature Review ◽

Primary Hyperparathyroidism ◽

Serum Levels ◽

Second Trimester ◽

Uncommon Disease ◽

Fetal Complications ◽

In Pregnancy

Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

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Pulmonary embolism: update on management and controversies

BMJ ◽

10.1136/bmj.m2177 ◽

2020 ◽

pp. m2177 ◽

Cited By ~ 2

Author(s):

Lisa Duffett ◽

Lana A Castellucci ◽

Melissa A Forgie

Keyword(s):

Pulmonary Embolism ◽

Risk Factor ◽

Venous Thromboembolism ◽

Recurrent Events ◽

Vitamin K Antagonists ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Therapeutic Options ◽

Systemic Thrombolysis ◽

Catheter Directed Thrombolysis ◽

Increased Risk

ABSTRACTPulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

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Thrombolytic therapy in acute venous thromboembolism

Hematology ◽

10.1182/hematology.2020000148 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 612-618

Author(s):

Thita Chiasakul ◽

Kenneth A. Bauer

Keyword(s):

Venous Thromboembolism ◽

Thrombolytic Therapy ◽

Postthrombotic Syndrome ◽

Term Survival ◽

Systemic Thrombolysis ◽

Thrombolytic Agents ◽

Catheter Directed Thrombolysis ◽

Response Team ◽

Acute Venous Thromboembolism ◽

Large Clot

Abstract Although anticoagulation remains the mainstay of treatment of acute venous thromboembolism (VTE), the use of thrombolytic agents or thrombectomy is required to immediately restore blood flow to thrombosed vessels. Nevertheless, systemic thrombolysis has not clearly been shown to improve outcomes in patients with large clot burdens in the lung or legs as compared with anticoagulation alone; this is in part due to the occurrence of intracranial hemorrhage in a small percentage of patients to whom therapeutic doses of a thrombolytic drug are administered. Algorithms have been developed to identify patients at high risk for poor outcomes resulting from large clot burdens and at low risk for major bleeding in an effort to improve outcomes in those receiving thrombolytic therapy. In acute pulmonary embolism (PE), hemodynamic instability is the key determinant of short-term survival and should prompt consideration of immediate thrombolysis. In hemodynamically stable PE, systemic thrombolysis is not recommended and should be used as rescue therapy if clinical deterioration occurs. Evidence is accumulating regarding the efficacy of administering reduced doses of thrombolytic agents systemically or via catheters directly into thrombi in an effort to lower bleed rates. In acute deep venous thrombosis, catheter-directed thrombolysis with thrombectomy can be used in severe or limb-threatening thrombosis but has not been shown to prevent postthrombotic syndrome. Because the management of acute VTE can be complex, having a rapid-response team (ie, PE response team) composed of physicians from different specialties may aid in the management of severely affected patients.

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Pragmatic Use of Catheter-Directed Thrombolysis in Venous Thromboembolism and a Comparative Evaluation With Traditional Therapies in Submassive Pulmonary Embolism

Journal of Pharmacy Practice ◽

10.1177/08971900211004833 ◽

2021 ◽

pp. 089719002110048

Author(s):

Mary Bradley ◽

Todd Bull ◽

Peter Hountras ◽

Robert MacLaren

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Group Versus ◽

Chart Audit ◽

Systemic Thrombolysis ◽

Ivc Filters ◽

Catheter Directed Thrombolysis ◽

Submassive Pulmonary Embolism ◽

Traditional Therapies

Background: Catheter-directed thrombolysis (CDT) is a novel treatment for venous thromboembolism (VTE). Limited data describe pragmatic use of CDT and compare CDT to other VTE therapies. Objective: Assess the use of CDT and comparatively evaluate CDT, anticoagulation, and systemic thrombolysis in submassive pulmonary embolism (PE). Methods: Retrospective, single-center, chart audit. Part 1 described all patients who received CDT for VTE. Part 2 matched patients with submassive PE who received CDT, heparin, or systemic thrombolysis and assessed length of stay (LOS), bleeding, all cause in-hospital mortality, and escalation of care. Results: For part 1, 70 CDT patients were identified; 42 with DVT and 28 with PE. ICU LOS was longer (2.5 ± 2.9 vs. 4.9 ± 8.4 days, p = 0.07), escalation of care more frequent (0% vs. 35.7%, p < 0.0001), and hospital mortality greater (2.4% vs. 21.4%, p = 0.014) in the PE group. For part 2, 21 CDT patients were matched to 21 heparin and 21 systemic thrombolysis patients. All CDT and tPA patients were admitted to the ICU versus only 6 (28.6%, p < 0.001) heparin patients. ICU LOS was significantly longer in the CDT group versus systemic tPA and systemic anticoagulation (80.7 ± 64.1 vs. 48.2 ± 27.7 vs. 24.9 ± 59.1 hours; p = 0.0048). More IVC filters and thrombectomies were performed in the CDT group. Conclusions: CDT is frequently used for both DVT and PE and requires ICU admission. Escalation of care is common when CDT is used for PE. For submassive PE, CDT is associated with prolonged ICU LOS compared to heparin or systemic thrombolysis. Resource utilization with CDT requires further evaluation.

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Faculty Opinions recommendation of Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727651280.793574717 ◽

2020 ◽

Author(s):

Teresa Woodruff

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Perinatal Outcomes ◽

In Pregnancy

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The secrets of placental mosaicism: clinical observation of the full form of confined placental trisomy 22 and literature review

10.21516/2413-1458-2020-19-1-35-40 ◽

2020 ◽

Author(s):

I.V. Komarova, A.A. Nikiforenko, A.V. Fedunyak

Keyword(s):

Prenatal Diagnosis ◽

Literature Review ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Clinical Observation ◽

Growth Restriction ◽

Favorable Outcome ◽

Full Form ◽

Placental Mosaicism ◽

In Pregnancy

Literature reports of placental mosaicism, including trisomy 22, were analyzed. The chance of correlation of placental aneuploidy with fetus aneuploidy, also the probability of complications in pregnancy and fetal growth restriction and postnatal patients growth in the cases of confined placental mosaicism, were demonstrated. The case of prenatal diagnosis of confined placental mosaicism of trisomy 22 with favorable outcome is presented. The necessity of cytogenic assay of amniocytes and fetal lymphocytes in the case of placental heteroploidy diagnosis was emphasized.

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Endovascular mechanical thrombectomy and stenting in a case of central vein thrombosis

BMJ Case Reports ◽

10.1136/bcr-2020-236508 ◽

2021 ◽

Vol 14 (2) ◽

pp. e236508

Author(s):

Rajesh Vijayvergiya ◽

Navjyot Kaur ◽

Saroj K Sahoo ◽

Ashish Sharma

Keyword(s):

Mechanical Thrombectomy ◽

Transluminal Angioplasty ◽

Brachiocephalic Vein ◽

Central Vein ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Stage Renal Disease ◽

End Stage ◽

Vein Stenosis

Central vein stenosis and thrombosis are frequent in patients on haemodialysis for end-stage renal disease. Its management includes anticoagulation, systemic or catheter-directed thrombolysis, mechanical thrombectomy and percutaneous transluminal angioplasty (PTA). Use of mechanical thrombectomy in central vein thrombosis has been scarcely reported. We hereby report a case of right brachiocephalic vein thrombosis with underlying stenosis, which was successfully treated by mechanical thrombectomy followed by PTA and stenting. The patient had a favourable 10 months of follow-up.

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