Thrombolytic Therapy in Pulmonary Thromboembolism

Acute pulmonary thromboembolism (PE) is a common disorder with significant mortality and morbidity. Timely recognition and prompt therapy of this disorder is essential to prevent adverse consequences. Thrombolytic therapy has an important role in the management of high-risk pulmonary embolism patients, where it can be lifesaving. However, the potential clinical benefit of thrombolytic therapy needs to balanced against the risk of major bleeding associated with the use of these agents. Hence patient selection is of paramount importance in determining the success of this therapy. Management strategies in PE are centered around the concept of risk stratification of the cases. In this chapter we briefly discuss the risk categorization of PE cases, followed by a more elaborative discussion of the role of thrombolytic therapy in the management of patients with high risk or intermediate risk PE.

Detection of Central Pulmonary Embolism on Non-Contrast CT

Background Pulmonary embolism (PE) is a common condition with considerable morbidity and mortality; it is more often diagnosed post-mortem by pathologists than in vivo by clinicians. Prompt and accurate diagnosis is difficult because PE may be clinically silent, the symptoms are vague and nonspecific, and in addition there is no definitive, non-invasive diagnostic test to establish its diagnosis. Objectives The aim of this study is to discuss the reliability and clinical effectiveness of the incidental detection of a PE on non-contrast CT which could be advantageous in the emergent context and also in patients with pre-existing renal disease or known allergies to contrast agents in a situation without viable alternative. Patients and Methods Results In our study CTA was used as the method of choice in detection of central pulmonary embolism in highly suspected pulmonary embolism in twenty patients and we compared it with pre contrast scan to identify non contrast CT reliability in detection of central pulmonary embolism. Our study showed that non contrast CT chest have a good role in detection of central pulmonary embolism as hyper dense lumen sign. Conclusion Unenhanced MDCT is an alternative approach for the diagnosis of acute central PE when CTPA is inaccessible or contraindicated. In our study Non-contrast chest CT scans have good role in evaluation of PE through detection the hyper dense lumen sign that is a good indicator of acute pulmonary thromboembolism particularly in cases involving the central pulmonary arteries.

Association of risk stratification and mortality outcomes in patients of acute pulmonary embolism

Background: To study the association of risk stratification and mortality outcomes of patients with high/intermediate risk acute pulmonary embolism who are given the guideline directed therapy after the diagnosis of pulmonary embolism.Methods: Prospective observational study of demographics, clinical profile, risk stratification, management and outcome of patients presenting with acute pulmonary embolism from October 2019to December 2020. Risk stratification was done as per ESC 2019 guidelines into high and intermediate categories, intermediate category patients were further stratified into intermediate-high and intermediate-low-risks.Results: 100 patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years with 60% being males were included in the study. There were 31 patients in high-risk group, 59 patients in intermediate-high subgroup, 10 patients in intermediate-low subgroup. Echocardiography was done in all patients. Outcome was relatively grave in these subgroups with overall mortality of 56 patients. 49 patients were thrombolysed with rTPA, 27patients with alteplase, 4 patients with streptokinase, 12patients who had contraindication to systemic thrombolysis were subjected to catheter directed thrombolysis and 8 patients were taken up for surgical embolectomy.Conclusions: Pulmonary embolism can present with unexplained dyspnea and atypical chest pain among other signs and symptoms. Early diagnosis, risk stratification and guideline directed prompt management can lead to favorable outcomes however; patients with high and intermediate risk at presentation are associated with higher mortality rate despite GDT.