Streptokinase vs alteplase in massive pulmonary embolism: A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction

Meneveau, Nicolas; Schiele, François; Vuillemenot, Alain; Valette, B; Grollier, Gilles; Bernard, Yvette; Bassand, Jean‐Pierre

doi:10.1093/oxfordjournals.eurheartj.a015410

Cited by 115 publications

(62 citation statements)

References 17 publications

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“…In the majority of survivors, thrombolysis as well as anticoagulation alone causes regression of clinical and echocardiographic symptoms of RV overload within 3-6 weeks. 4,9 In addition, pulmonary angiographic studies revealed that in most cases of APE the resolution of thromboemboli occurred within 21 days. 5 However, it was reported that in some patients after APE, residual perfusion defects could be detected by control lung scintygraphy or spiral computer tomography even in spite of adequate long-term treatment.…”

Section: Discussionmentioning

confidence: 99%

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Ciurzyński

Kurzyna²,

Bochowicz

et al. 2004

Clinical Cardiology

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SummaryBackground and hypothesis: Hemodynamic and functional consequences of acute pulmonary embolism (APE) are believed to be reversible with antithrombotic treatment. To verify this hypothesis, we reassessed our patients at least 1 year after an episode of APE.Methods: We compared echo Doppler indices and 6-min walking test parameters (6-MWT) of 36 patients (13 men, 23 women, age 66 ± 11 years), studied on average 3.1 ± 2.2 years after an acute episode of pharmacologically treated massive or submassive APE, with data of 30 age-matched subjects (12 men, 18 women, age 67 ± 12 years).Results: At least 1 year after APE, right ventricular (RV) diameter remained increased in patients compared with controls (27 ± 2 vs. 23 ± 2 mm, p < 0.001). Also, acceleration time of pulmonary ejection (AcT) was markedly shorter (97 ± 19 vs. 123 ± 19 ms, p < 0.001) and the diameter of the pulmonary trunk was significantly larger in patients than in controls (21 ± 2.6 vs. 18 ± 2.2, p < 0.001). Although the mean value of the tricuspid valve peak systolic gradient (TVPG) in the APE group at follow-up was similar to that in controls, TVPG > 30 mmHg was recorded in three patients with APE (8.3%). There was no difference in the distance of 6-MWT between both groups; however, the mean desaturation after 6-MWT was higher in the APE group than in controls (3.04 ± 2.08 vs. 1.45 ± 0.69%, p = 0.0005).

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Section: Discussionmentioning

confidence: 99%

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Ciurzyński

Kurzyna²,

Bochowicz

et al. 2004

Clinical Cardiology

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“…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. The major risks associated with pulmonary thrombolysis include bleeding, hematoma formation at puncture sites, and intracranial hemorrhage, with intracranial hemorrhage occurring in approximately 2% of patients, ensuing up to 14 days following thrombolysis.…”

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

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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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“…SK is used as an effective and inexpensive thrombolysis medication in some cases of myocardial infarction (heart attack) (Sikri and Bardia, 2007) and pulmonary embolism (Meneveau et al, 1997). The plant represents an enormous reservoir of biologically active compounds with various chemical structures and protective/disease preventive properties (phytochemicals).…”

Section: Introductionmentioning

confidence: 99%

Thrombolytic and Cytotoxic Activities of Terminalia bellerica Roxb.

et al. 2015

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The present study was designed to investigate the thrombolytic activity and cytotoxic potential of the methanolic extract of bark of Terminalia bellerica Roxb. The cytotoxicity was assessed with the brine shrimp lethality bioassay and thrombolytic effect with human blood. The brine shrimp lethality bioassay was used to evaluate cytotoxicity (LC 50 = 3.21 µg/ml) compared to vincristine of sulphate (LC 50 = 0.512 µg /ml). It was also evaluated as thrombolytic agent as compared to streptokinase. It has significant thrombolytic activity (32.95%) compared to standard streptokinase (70%).

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Streptokinase vs alteplase in massive pulmonary embolism: A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction

Cited by 115 publications

References 17 publications

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

Long‐term effects of acute pulmonary embolism on echocardiographic doppler indices and functional capacity

A critical review of thromboembolic complications associated with central venous catheters

Thrombolytic and Cytotoxic Activities of Terminalia bellerica Roxb.

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