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 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 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 PROGNOSTIC VALUE OF RIGHT VENTRICULAR DYSFUNCTION IN SUBMASSIVE PULMONARY EMBOLISM

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A2200
Author(s):  
Victor Prado ◽  
Avantika Nathani ◽  
Rabab Nasim ◽  
Sairam Raghavan ◽  
Naveen Prasath Baskaran ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Submassive Pulmonary Embolism

Mechanical circulatory assist for pulmonary embolism

Perfusion ◽  
2000 ◽  
Vol 15 (6) ◽  
pp. 527-529 ◽  
Author(s):  
Yoshio Misawa ◽  
Katsuo Fuse ◽  
Tsutomu Yamaguchi ◽  
Tsutomu Saito ◽  
Hiroaki Konishi
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Haemodynamic Instability ◽  
Cardiopulmonary Support ◽  
Attractive Option ◽  
Surgical Embolectomy ◽  
Poor Outcomes

Optimal management of acute pulmonary embolism remains controversial, despite advances in thrombolytic therapy. Haemodynamic instability and, in particular, right ventricular dysfunction is associated with poor outcomes. Urgent surgical embolectomy has been the treatment of choice in this category of patients. We present two cases in which percutaneous cardiopulmonary support (PCPS) was used as an adjunct to thrombolytic therapy for progressive circulatory collapse secondary to massive acute pulmonary embolism. This experience suggests that PCPS may offer an attractive option for a condition which continues to carry significant morbidity and mortality.

scholarly journals Thrombolytic Therapy in Normotensive Patients with Pulmonary Embolism (Data from the Retrospective Study)

2020 ◽  
Vol 16 (5) ◽  
pp. 742-748
Author(s):  
N. A. Сherepanova ◽  
I. S. Mullova ◽  
A. R. Kiselev ◽  
T. V. Pavlova ◽  
S. M. Khokhlunov ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Troponin I ◽  
Varicose Veins ◽  
Right Ventricular Dysfunction ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Background. The thrombolytic therapy is absolutely recommended for patients in shock or hypotension because the benefits are clearly outweighing the risks. However, in hemodynamically stable patients, including those with acute right ventricular dysfunction and/or myocardial damage, thrombolysis has a significantly lower evidence level.Aim. To study the criteria based on which doctors decide to conduct thrombolytic therapy in normotensive patients in real clinical practice according to the retrospective data.Material and methods. A single-center retrospective cohort study analyzed medical records of patients hospitalized in 2006-2017 with a verified diagnosis of pulmonary embolism (PE) and who had a systolic blood pressure >90 mm Hg at the time of admission.Results. The present study population included 299 patients with a verified diagnosis of PE from 2006 to 2017 years. Patients were divided into two groups: with thrombolysis (group 1) and without thrombolysis (group 2). Logistic regression analysis showed that age younger than 60 years, the presence of varicose veins of the lower extremities, skin cyanosis, syncope in the debut of PE were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis. Increased troponin I, right ventricular dysfunction, and the severity of PE according to the PESI score showed no significant impact on this decision. In-hospital mortality in the group 2 was 1.9% (5 patients), while there were no deaths in the group 1. But the analysis of the association of thrombolysis with survival was difficult to perform due to the low incidence of deaths and the small number of patients in the group with thrombolysis (odds ratio 0.34; 95% confidence interval 0.03-8.18; р=0.856). No major bleeding was registered in any group.Conclusion. We were not able to clearly identify independent clinical or instrumental factors that influence the decision to perform thrombolysis in patients with PE outside the framework of evidence-based medicine. Further research is needed.

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