Effectiveness of intravenous rTPA in the treatment of massive pulmonary embolism and right heart thromboembolism

Cuccia, Claudio; Campana, Marco; Franzoni, Patrícia; Faggiano, Pompilio; Volterrani, Maurizio; Musmeci, G.; Visioli, O

doi:10.1016/0002-8703(93)91075-p

Cited by 20 publications

(14 citation statements)

References 9 publications

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“…Seventeen studies (including 1 published only in abstract form) were nonhuman, nonrandomized, and/or evaluated the use of surgical or percutaneous mechanical thrombolysis. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] These studies were excluded. Six reported identical or long-term follow-up data on patients or subgroups of patients previously or subsequently included in other or more complete reports.…”

Section: Study Selectionmentioning

confidence: 99%

Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: A meta-analysis of the randomized controlled trials

Wan¹,

Quinlan²,

Agnelli³

et al. 2004

ACC Current Journal Review

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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.

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Section: Study Selectionmentioning

confidence: 99%

Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: A meta-analysis of the randomized controlled trials

Wan¹,

Quinlan²,

Agnelli³

et al. 2004

ACC Current Journal Review

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“…6,7 Akut miyokard infarktüsü, periferik arter tıkanıklığı, kalp kapak trombozu ve akut pulmoner embolide trombolitik tedavi etkin ve yaygın şekilde kullanılmaktadır. [8][9][10] Yeni oluşmuş trombüslerde daha etkin olmak üzere, sol ventrikül trombüslerinin trombolitik tedavi ile çözüldüğü bildirilmiştir. 262 temik emboli gelişmeksizin kardiyak trombüsün kaybolduğunu bildirmişlerdir.…”

Section: Discussionunclassified

Successful Lysis of a Left Ventricular Apical Thrombus by Thrombolitic Therapy:Case Reports

Bayramoğlu¹,

Günaydın²,

Bektaş³

et al. 2016

Turkiye Klinikleri J Case Rep

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Ö ÖZ ZE ET T Sol ventrikül içerisinde gelişmiş olan trombüslerin tedavisinde net bir yaklaşım bulunmamaktadır. Emboli riski yüksek ve cerrahi müdahalenin mümkün olmadığı sol ventrikül trombüsle-rinde trombolitik tedavi uygulanabilmektedir. Sol ventrikül trombüslerinde trombolitik doz şeması ve infüzyon süresi ile ilgili net bir bilgi bulunmamaktadır. Ankilozan spondilit nedeni ile takip edilen 37 yaşındaki erkek olgu, 3 gün önce başlayan nefes darlığı şikâyeti ile başvurdu. Ekokardiyografisinde sol ventrikül sistolik fonksiyonlarında azalma ve sol ventrikül apeksinde hareketli trombüs saptandı. Olguya yüksek cerrahi risk nedeni ile 100 mg t-PA verilmesi planlandı. İnfüz-yonun dördüncü saatinde yapılan ekokardiyografide trombüsün tamamen kaybolduğu görüldü. Tedavi dozu ve infüzyon süresini belirlemede erken ve sık aralıklı ekokardiyografik değerlendirme etkili bir seçenek olabilir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Ekokardiyografi; tromboz A AB BS S T TR RA AC CT T There is no a clear approach in the treatment of thrombus in the left ventricle, thrombolytic therapy can be performed in left ventricular thrombi with high risk of embolism and inappropriate surgical intervention. There is no clear information on dosage schedule and duration of thrombolytic infusion in left ventricular thrombi. 37 years-old-man who had ankylosing spondylitis was admitted to our department with dispne. Decreased left ventricular systolic function and a mobile thrombus were detected on echocardiogram. Administration of 100 mg t-PA was planned due to the high risk of surgery. Thrombus dissolution was seen at fourth hour after infusion on echocardiography. Early echocardiographic assessment can be an effective option for determination of treatment dose and infusion time. Adil BAYRAMOĞLU, 1 Antikoagülan tedaviler ve cerrahi prosedürler uygulanabilmektedir. Yüksek sistemik emboli riski taşıyan ve cerrahi tedavinin kontrendike olduğu durumlarda trombolitik tedavi düşünülmelidir.2-4 Trombolitik tedavinin dozu ve infüzyon süresi tartışmalıdır. Bu çalışmada, sol ventrikül apeksinde saptanan intraventriküler trombüsün düşük doz ve kısa süreli doku plazminojen aktivatörü (t-PA) infüzyonu ile tamamen çözüldüğü, trombolitik tedavi infüzyon süresi erken dönem ve sık aralıklarla yapılan

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“…Few papers report on the efficacy and safety of thrombolytic therapy in right heart thromboembolism [1,4,5,13]. Fragmentation of a right heart mass leading to clinical deterioration has never been described following thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors support immediate surgical embolectomy, whereas others advocate conventional therapy using systemic heparin. The efficacy and safety of thrombolytic therapy in this condition remains to be established [1][2][3][4][5]. We report two cases of right heart emboli-in-transit which were successfully treated by early and delayed initiated thrombolytic treatment, respectively.…”

mentioning

confidence: 96%

Thrombolytic therapy of right heart emboli-in-transit

Jessurun¹,

Brügemann²,

Hamer³

et al. 1995

Eur Respir J

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T Th hr ro om mb bo ol ly yt ti ic c t th he er ra ap py y o of f r ri ig gh ht t h he ea ar rt t e em mb bo ol li i--i in n--t tr ra an ns si it t G.A.J. Jessurun*, J. Brügemann*, J.P.M. Hamer*, J.P.H. Römer**, K.I. Lie* ABSTRACT: Currently, no consensus exists for the appropriate treatment of echocardiographically diagnosed mobile right heart masses giving rise to a high suspicion of migrant thromboembolism in patients with pulmonary embolism. This may lead to unnecessary delay in the implementation of the most appropriate treatment for these patients.Several earlier studies have supported the beneficial role of thrombolytic therapy. We report on an additional two patients with mobile right heart thromboemboli, refractory to systemic anticoagulation, who recovered quickly after initiation of thrombolytic therapy.

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Effectiveness of intravenous rTPA in the treatment of massive pulmonary embolism and right heart thromboembolism

Cited by 20 publications

References 9 publications

Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: A meta-analysis of the randomized controlled trials

Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: A meta-analysis of the randomized controlled trials

Successful Lysis of a Left Ventricular Apical Thrombus by Thrombolitic Therapy:Case Reports

Thrombolytic therapy of right heart emboli-in-transit

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