Successful resuscitation with thrombolysis of pulmonary embolism due to thrombotic thrombocytopenic purpura during cardiac arrest

Zhu, Tao; Pan, Konhan; Wang, Yonggang

doi:10.1016/j.ajem.2014.06.025

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…We reviewed all works on the subject, including experimental and clinical studies. Table 2 presents our summaries of the case reports we identified on this literature search on this topic [ 6-9 ].…”

Section: Discussionmentioning

confidence: 99%

“…ROSC can be an indirect measure of success, as earlier achievement can lead to better outcomes. The literature review yielded some extraordinary examples of situations in which thrombolytics provided a mortality benefit [ 6-9 ]. However, our review showed that the case reports in Table 2 may be exceptions to the rule, and thrombolytic therapy may need to be used on a case-by-case basis.…”

Section: Discussionmentioning

confidence: 99%

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Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism

et al. 2016

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BackgroundTissue plasminogen activator (tPA) is used emergently to dissolve thrombi in the treatment of fulminant pulmonary embolism. Currently, there is a relative contraindication to tPA in the setting of traumatic or prolonged cardiopulmonary resuscitation > 10 minutes because of the risk of massive hemorrhage.MethodsOur single-center, retrospective study investigated patients experiencing cardiac arrest (CA) secondary to pulmonary embolus. We compared the effectiveness of advanced cardiac life support with the administration of tPA vs. the standard of care consisting of advanced cardiac life support without thrombolysis. The primary endpoint was survival to discharge. Secondary endpoints were return of spontaneous circulation (ROSC), major bleeding, and minor bleeding.ResultsWe analyzed 42 patients, of whom 19 received tPA during CA. Patients who received tPA were not associated with a statistically significant increase in survival to discharge (10.5% vs. 8.7%, P = 1.00) or ROSC (47.4% vs. 47.8%, P = 0.98) compared to the control group. We observed no statistically significant difference between the groups in major bleeding events (5.3% in the tPA group vs. 4.3% in the control group, P = 1.00) and minor bleeding events (10.5% in the tPA group vs. 0.0% in the control group, P = 0.11).ConclusionThis study did not find a statistically significant difference in survival to discharge or in ROSC in patients treated with tPA during CA compared to patients treated with standard therapy. However, because no significant difference was found in major or minor bleeding, we suggest that the potential therapeutic benefits of this medication should not be limited by the potential for massive hemorrhage. Larger prospective studies are warranted to define the efficacy and safety profile of thrombolytic use in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism

et al. 2016

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“…Anecdotal case reports have successfully applied all the available therapeutic tools that have saved the lives of TTP patients with life-threatening cardiopulmonary complications. These reports have documented successful primary percutaneous coronary intervention (PCI) in the setting of ongoing STEMI with angiographic evidence of epicardial coronary artery occlusions[22], thrombolytic therapy for massive pulmonary embolism or STEMI in the setting of TTP[25,26], extracorporeal membrane oxygenation (ECMO) support for cardiogenic shock due to acute global ischemia resulted from diffuse microthrombi, to subsequent heart transplantation after the resolution of TTP[27]. Hemodynamic support and targeted treatment for cardiac complications of TTP may provide the opportunity for TTP-targeted therapy to take effect and eventually improve mortality, particularly in cases of severe TTP with hemodynamically-compromising cardiac complications.…”

Section: Treatment For Cardiac Complications In Ttpmentioning

confidence: 99%

Cardiac implications of thrombotic thrombocytopenic purpura

Wiernek¹,

Jiang²,

Gustafson³

et al. 2018

WJC

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Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder that essentially can affect any organ in the human body. The hallmark of the pathogenesis in TTP is the large von Willebrand factor multimers on platelet-mediated micro-thrombi formation, leading to microvascular thrombosis. Autopsy studies showed that cardiac arrest and myocardial infarction are the most common immediate causes of death in these patients. Clinical manifestations of cardiac involvement in TTP vary dramatically, from asymptomatic elevation of cardiac biomarkers, to heart failure, MI and sudden cardiac death. There is limited knowledge about optimal cardiac evaluation and management in patients with TTP. The absence of typical cardiac symptoms, combined with complicated multi-organ involvement in TTP, may contribute to the under-utilization of cardiac evaluation and treatment. Prompt diagnosis and timely initiation of effective therapy could be critically important in selected cases. Based on our experience and this review of the literature, we developed several recommendations for focused cardiac evaluation for patients with acute TTP: (1) patients with suspected or confirmed TTP should be screened for the potential presence of cardiac involvement with detailed history and physical, electrocardiogram and cardiac enzymes; (2) clinical deterioration of TTP patients warrants immediate cardiac reevaluation; (3) TTP patients with clinical evidence of cardiac involvement should be monitored for telemetry, cardiac biomarkers and evaluated with transthoracic echocardiography. These patients require urgent targeted TTP treatment as well as cardiac-specific treatment. Aspirin therapy is indicated for all TTP patients. Since epicardial coronary artery involvement is rare, cardiac catheterization is usually not required, given the high risk for hemorrhage and kidney injury; (4) we recommend evidence-based medical therapy for ischemic symptoms and heart failure. TTP patients with evidence of cardiac involvement would also benefit from routine cardiology follow up during remission.

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“…The role of hematologic disorders in the etiology of PE could be related to various factors that are associated with both increased coagulability and hemorrhagic disorders, and the association between pulmonary embolism and thrombotic thrombocytopenic purpura or von Willebrand disease has been described in various publications. 6,7 Another interesting finding of the study is related to the increased mortality in patients with underlying renal or pulmonary disease. These conditions are usually associated with exacerbated inflammation, and inflammation is often accompanied by a pro-thrombotic state.…”

mentioning

confidence: 94%

The Neglected Role of Hematologic Disorders in Pulmonary Embolism

Nagler

2016

Journal of Cardiovascular Emergencies

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Successful resuscitation with thrombolysis of pulmonary embolism due to thrombotic thrombocytopenic purpura during cardiac arrest

Cited by 8 publications

References 15 publications

Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism

Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism

Cardiac implications of thrombotic thrombocytopenic purpura

The Neglected Role of Hematologic Disorders in Pulmonary Embolism

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