Systemic Thrombolytic Therapy for Massive and Submassive Pulmonary Embolism

Igneri, Lauren; Hammer, J

doi:10.1177/0897190018767769

Cited by 17 publications

(15 citation statements)

References 49 publications

(120 reference statements)

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“…Massive PE is a rare but life‐threatening form of VTE that poses a significant challenge in postoperative patients 1,4,6 . In patients with contraindications to systemic tPA, endovascular interventions are now increasingly favored over traditional surgical thrombectomy due to decreased rates of morbidity and mortality 7,8,10 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients presenting with massive PE have a mortality rate of up to 30%–50% 2,4,5 . Postoperative massive PE poses a significant challenge as recent surgery is often an absolute contraindication to systemic tissue plasminogen activator (tPA) due to bleeding risks 6 . In such cases, surgical thrombectomy is often possible but carries a high morbidity and mortality rate 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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VA‐ECMO‐assisted aspiration thrombectomy in a patient presenting with acute massive PE with absolute contraindications to thrombolytics

Patel

Mujer

John

et al. 2022

Cathet Cardio Intervent

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Massive pulmonary embolism (PE) is a life‐threatening complication of major surgery with a mortality rate up to 50%. First‐line therapy for massive PE is systemic thrombolytics, but surgical patients are at high bleeding risk with absolute contraindications. As surgical thrombectomy carries a high burden of morbidity and mortality, endovascular interventions are becoming more common in these clinical scenarios. We report a case of a neurosurgical patient whose postoperative course was complicated by massive PE and subsequent cardiac arrest that required emergent venoarterial extracorporeal membrane oxygenation, followed by aspiration thrombectomy with the Inari FlowTriever Device (Inari Medical). The patient had immediate hemodynamic improvement with eventual recovery to baseline functional status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

VA‐ECMO‐assisted aspiration thrombectomy in a patient presenting with acute massive PE with absolute contraindications to thrombolytics

Patel

Mujer

John

et al. 2022

Cathet Cardio Intervent

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“…The use of thrombolytic therapy is another treatment approach for the management of patients with acute PE. While thrombolytic therapy is advised in patients with massive PE to mitigate hemodynamic collapse, its benefit in patients with submassive PE is less well-defined given the increased risk of major and minor bleeding [ 8 ]. A meta-analysis of 16 studies was performed to compare the use of thrombolytic therapy and anticoagulation in patients with PE.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Pulmonary Embolism Masked by New-Onset Atrial Fibrillation with Rapid Ventricular Rate: The Role of Mechanical Thrombectomy

et al. 2022

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Patient: Male, 70-year-old Final Diagnosis: Atrial fibrillation • pulmonary embolism Symptoms: Dyspnea Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Management of atrial fibrillation (AF) with rapid ventricular rate in the setting of submassive pulmonary emboli (PE) has not been well defined in the literature. It is challenging as the hemodynamics caused by a PE can change the management of AF. We report a case of bilateral PE masked by new-onset AF with rapid ventricular rate that was treated pharmaceutically and mechanically, with thrombectomy. Case Report: An 85-year-old man presented with gradual dyspnea and was found to be in AF with rapid ventricular rate (~160–180 bpm). The patient had tachypnea and hypoxia requiring oxygen administration. On physical examination, he had euvolemia. Chest X-ray did not reveal pulmonary vascular congestion. He was started on standard AF management with atrioventricular nodal blockers. Laboratory tests revealed a normal troponin level but mildly elevated B-type natriuretic peptide and lactate. Because his dyspnea was out of proportion to the physical examination, radiographic, and laboratory findings, a D-dimer level was obtained and was elevated. Computed tomography with pulmonary angiogram showed extensive bilateral PE. An echocardiogram (TTE) showed evidence of right ventricular failure. The patient underwent mechanical thrombectomy with clot retrieval, deterring the risk of hemodynamic collapse that would have ensued with atrioventricular nodal blockers monotherapy. On repeat TTE, right ventricular dysfunction was completely resolved and the remaining hospitalization was uneventful. Conclusions: In patients with concomitant AF with rapid ventricular rate and submassive PE, the use of mechanical thrombectomy, in addition to the standard AF management, could be beneficial in deterring the risk of hemodynamic collapse.

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“…PE may be classified as high risk, intermediate, or low risk. When patients with acute pulmonary embolism present with hypotension defined as a systolic blood pressure <90mmHg or drop of >40mmHg, not explained by another cause, this is referred to as high risk PE in the European Guidelines [12, 13]. Thrombolytic therapy should be administered unless contraindicated, as the 30-day mortality risk is greater than 15% in this population.…”

Section: Discussionmentioning

confidence: 99%

“…American College of Chest Physicians guidelines suggest that recent surgery, excluding recent brain or spinal surgery or trauma, is a relative contraindication and that the bleeding risk reduces significantly 2weeks after surgery. [12].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism following Percutaneous Nephrolithotomy: An Uncommon and Life-Threatening Complication

Paparidis

Katsimantas

Oikonomidis

et al. 2019

Case Reports in Urology

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High risk pulmonary embolism is a rare and life-threatening complication following percutaneous nephrolithotomy. We report the case of a previously healthy, 44-year-old male, who developed acute pulmonary embolism following right percutaneous nephrolithotomy. On the 1st postoperative day, the patient presented with hemodynamic instability, acute respiratory distress, hypoxia, and loss of consciousness. He was urgently intubated and placed on mechanical ventilation. Clinical findings set the suspicion of pulmonary embolism with shock. Chest computed tomography scan confirmed the diagnosis. The patient underwent urgent thrombolysis in the cardiac care unit. On the 2nd postoperative day, the patient was admitted to the intensive care unit due to hemodynamic instability and fever. The postoperative course was complicated by right renal bleeding on the 3rd postoperative day, which was managed through angiography and angioembolization of the lower segmental right renal artery, followed by recurrent respiratory and urinary tract infections. The patient was transferred back to the urology department on the 66th postoperative day and was discharged seven days later.

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Systemic Thrombolytic Therapy for Massive and Submassive Pulmonary Embolism

Cited by 17 publications

References 49 publications

VA‐ECMO‐assisted aspiration thrombectomy in a patient presenting with acute massive PE with absolute contraindications to thrombolytics

VA‐ECMO‐assisted aspiration thrombectomy in a patient presenting with acute massive PE with absolute contraindications to thrombolytics

Bilateral Pulmonary Embolism Masked by New-Onset Atrial Fibrillation with Rapid Ventricular Rate: The Role of Mechanical Thrombectomy

Pulmonary Embolism following Percutaneous Nephrolithotomy: An Uncommon and Life-Threatening Complication

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