Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

Murphy, Jennifer; Mulvihill, Niall; Mulcahy, David; Foley, Brendan; Smiddy, Pauline; Molloy, Martin

doi:10.1007/s003300050776

Cited by 41 publications

(18 citation statements)

References 27 publications

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“…For PE with RHTE, case reports and case series have documented resolution of RAT using a glycoprotein IIb/IIIa receptor antagonist (abciximab) with concurrent heparin administration 70 and endovascular embolectomy with basket retrieval through a femoral approach, respectively. 71,72 Catheter thrombectomy, with 73 or without [74][75][76][77] local thrombolysis, has been shown to permit rapid RV recovery following fragmentation. Advantages of the latter strategy include avoidance of major surgery in high-risk patients and a decreased risk of bleeding.…”

Section: Catheter-directed Thrombolysismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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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.

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Section: Catheter-directed Thrombolysismentioning

confidence: 99%

A critical review of thromboembolic complications associated with central venous catheters

Burns

McLaren

2008

Can J Anesth/J Can Anesth

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“…Death may ensue within minutes due to cardiotoxic and neurotoxic agents in the venom that can produce ventricular arrhythmias and cardiac arrest, and respiratory failure, respectively. In a retrospective review of 12 serious cases [47][48][49][50][51], pulmonary edema was a regular feature after an initial phase of mild skin pain followed 30 min after the sting by considerable muscle pain and cramps, tachycardia and hypertension. At a mean time of 14 h (range 1.5~18 h) after the sting pulmonary edema was evident radiologically and in some cases was associated with hypokinetic cardiac dysfunction, reduced cardiac output and raised serum cardiac enzymes.…”

Section: Systematic Symptomsmentioning

confidence: 99%

Jellyfish Envenomation with Skin and Cardiovascular Manifestations and Treatments

Bais¹,

Che²,

Jiang³

et al. 2017

Toxicol Open Access

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Jellyfish are smooth-formed animals in the phylum cnidaria, living in around coastal water zones worldwide. Interacting with jellyfish tentacles, even the beached and dying jellyfish, can prompt millions of nematocysts to perforate the skin and infuse the venom through the inverted long spiny tubules, thereby causing toxic manifestations from no effect to extreme pain to death. According to the structure of nematocyst, quantitative toxins are released into body in a short time. Stung by jellyfish possesses a wide spectrum of toxic effects especially on skin and cardiovascular toxicities. However, the mechanism of jellyfish venom is not clear. In this review, we focus on Jellyfish toxins, symptoms and treatment after sting in order to reduce treatment time, improve the survival rate for medical providers and to set a reference for follow-up study.

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“…Several authors have convincingly demonstrated that pulmonary artery thrombus burden can be reduced by mechanical thrombus fragmentation using catheter devices with or without local thrombolysis, thereby ensuring rapid right ventricular recovery [41, 42, 43, 44, 45]. There are no data as to whether this approach is more effective than systemic thrombolysis.…”

Section: Mechanical Thrombus Fragmentation With or Without Local Thromentioning

confidence: 99%

New Therapeutic Approaches in Pulmonary Embolism

Schellong¹,

Schmidt²

2003

Respiration

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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis.

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Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

Cited by 41 publications

References 27 publications

A critical review of thromboembolic complications associated with central venous catheters

A critical review of thromboembolic complications associated with central venous catheters

Jellyfish Envenomation with Skin and Cardiovascular Manifestations and Treatments

New Therapeutic Approaches in Pulmonary Embolism

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