Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion

Goldhaber, Samuel Z.; Come, Patricia C.; Lee, R.T.; Braunwald, Eugene; Parker, J. Anthony; Haire, William D.; Feldstein, Michael; Miller, Michael R.; Toltzis, Robert J.; Smith, Jordyn; Silva, A.M. Taveira de; Mogtader, Allen; McDonough, Timothy

doi:10.1016/0140-6736(93)90274-k

Cited by 770 publications

(451 citation statements)

References 12 publications

Supporting

Mentioning

402

Contrasting

Unclassified

Order By: Relevance

“…47,48 Recombinant tissue plasminogen activator is typically infused over two hours, compared to a 12-hr infusion with streptokinase and up to 24 hr of administration with urokinase. Evidence from RCTs, reporting on patients with massive [49][50][51][52][53][54] and submassive 52,55 PE, favour thrombolysis over heparinization. Randomized controlled trials comparing streptokinase and alteplase, in massive PE, 56,57 and urokinase and rTPA 58 failed to demonstrate superiority of one thrombolytic over another.…”

Section: Systemic Thrombolysismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: Central venous catheters (CVC) are commonly used in critical care. While thrombosis is a well-recognized and frequent complication associated with their use, CVC-related thromboembolic complications, including pulmonary embolism (PE) and right heart thromboembolism (RHTE), occur less frequently and often evade diagnosis. Little information exists to guide clinicians in the diagnosis and management of CVC-related thromboembolic complications. Source:We critically review and synthesize the literature highlighting the incidence of CVC-related thrombosis. We highlight the risk for developing thromboembolic complications and provide approaches to diagnosing and managing RHTE. Principle findings:The incidence of CVC-related thrombosis varies depending on patient, site, instrument, and infusaterelated factors. Central venous catheters-related thrombosis represents an important source of morbidity and mortality for affected patients. Pulmonary embolism occurs in approximately 15% of patients with CVC-related upper extremity deep venous thrombosis (UEDVT). More frequent use of transesophageal echocardiography, in patients with suspected and confirmed PE, has resulted in increased detection of RHTE. While it is recognized that the occurrence of RHTE, in association with PE, increases mortality, the optimal strategy for their management has not been established in a clinical trial. Conclusion:Central venous catheter-related thrombosis occurs frequently and represents an important source of morbidity and mortality for affected patients. Our review supports that surgery and thrombolysis have both been demonstrated to enhance survival in patients with RHTE and PE. However, important patient, clot, and institutional considerations mandate that treatment for patients with RHTE and PE be individualized.

show abstract

Section: Systemic Thrombolysismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…14,47,53 Information about proper concealment of the treatment allocation was provided in 5 trials. [45][46][47]53,54 Both patients and investigators were blinded to treatment allocation in 3 of the 11 trials. 14,50,51 The number of patients lost to follow-up was not reported in any of the trials.…”

Section: Study Qualitymentioning

confidence: 99%

Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism

et al. 2004

View full text Add to dashboard Cite

Background-Randomized trials and meta-analyses have reached conflicting conclusions about the role of thrombolytic therapy for the treatment of acute pulmonary embolism. Methods and Results-We performed a meta-analysis of all randomized trials comparing thrombolytic therapy with heparin in patients with acute pulmonary embolism. Eleven trials, involving 748 patients, were included. Compared with heparin, thrombolytic therapy was associated with a nonsignificant reduction in recurrent pulmonary embolism or death (6.7% versus 9.6%; OR 0.67, 95% CI 0.40 to 1.12, P for heterogeneityϭ0.48), a nonsignificant increase in major bleeding (9.1% versus 6.1%; OR 1.42, 95% CI 0.81 to 2.46), and a significant increase in nonmajor bleeding (22.7% versus 10.0%; OR 2.63, 95% CI 1.53 to 4.54; number needed to harmϭ8). Thrombolytic therapy compared with heparin was associated with a significant reduction in recurrent pulmonary embolism or death in trials that also enrolled patients with major (hemodynamically unstable) pulmonary embolism (9.4% versus 19.0%; OR 0.45, 95% CI 0.22 to 0.92; number needed to treatϭ10) but not in trials that excluded these patients (5.3% versus 4.8%; OR 1.07, 95% CI 0.50 to 2.30), with significant heterogeneity between these 2 groups of trials (Pϭ0.10). Conclusions-Currently available data provide no evidence for a benefit of thrombolytic therapy compared with heparin for the initial treatment of unselected patients with acute pulmonary embolism. A benefit is suggested in those at highest risk of recurrence or death. The number of patients enrolled in randomized trials to date is modest, and further evaluation of the efficacy and safety of thrombolytic therapy for the treatment of high-risk patients with acute pulmonary embolism appears warranted.

show abstract

“…Asimismo, otorga información pronóstica al medir tamaño del ventrículo derecho, y permite descartar diagnósticos alternativos 7 . El algoritmo prosigue con la ECTT, que evalúa función ventricular derecha, estratifica el riesgo inicial (alto, intermedio o bajo) con la ventaja de ser bedside, y ofrece la potencialidad de guiar el tratamiento, sea al inicio o en el seguimiento 8 . Ambos exáme-nes se realizaron al ingreso y en el seguimiento de nuestro caso.…”

Section: Discussionunclassified

Tromboembolismo pulmonar masivo con respuesta exitosa a trombolisisfarmacológica: Caso clínico

et al. 2010

View full text Add to dashboard Cite

show abstract

Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion

Cited by 770 publications

References 12 publications

A critical review of thromboembolic complications associated with central venous catheters

A critical review of thromboembolic complications associated with central venous catheters

Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism

Tromboembolismo pulmonar masivo con respuesta exitosa a trombolisisfarmacológica: Caso clínico

Contact Info

Product

Resources

About