Thrombolytic therapy for pulmonary embolism

Abstract

Analysis 2.1. Comparison 2 Thrombolytic therapy versus heparin: primary outcome measures (sensitivity analysis according to study quality), Outcome

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

“…We also abstracted the following treatment-related variables: use of statins and antiplatelet drugs at baseline, 19,3 type of initial anticoagulation, 18 systemic and catheter-related thrombolysis, 17 the insertion of a vena cava filter, 2 and all INR values measured during follow-up. 16…”

“…Several patient characteristics are associated with recurrent venous thromboembolism, including age, 3,4 male sex, 3,5 obesity, 4 localization of venous thromboembolism, 6,7 unprovoked venous thromboembolism, 3,8 cancer-related venous thromboembolism, 2,3 prior venous thromboembolism, 9 family history of venous thromboembolism, 10 inflammatory bowel disease, 11 chronic heart failure, 12 leg paresis, 13 varicose veins, 4 elevated D-dimer at baseline, 14 or thrombophilia. 10,15 Treatment-related factors associated with venous thromboembolism recurrence include a suboptimal anticoagulation quality and the insertion of a vena cava filter, 2,16 whereas thrombolysis, 17 initial therapy with lowmolecular-weight heparin (LMWH), 18 and concomitant use of statins or antiplatelet therapy may have a protective effect. 3,19 Bleeding episodes may also be followed by a higher risk of recurrent venous thromboembolism, possibly owing to the interruption of anticoagulation.…”

A 54-Year-Old Woman With Chest Pain and Shortness of Breath

“…The treatment of submassive PE requires a decision of using anticoagulation alone vs more aggressive thrombolytic therapy. Thrombolytic therapy can reduce hemodynamic decompensation, 5 modestly reduce mortality, 6 reduce pulmonary hypertension in the short and long term, 7 and reduce RV pressure at 6 months, 8 but comes with a risk of intracranial hemorrhage. 5,6 Our bedside ultrasound assessment allowed for real-time evaluation of RV size, RV function, RVSP, and RV strain, which identified the patient in our study as high risk.…”

Pulmonary embolism: update on management and controversies

“…Thrombolytic therapy, either systemic (most common) or directed by a catheter into the pulmonary arteries, can be used to accelerate the resolution of acute pulmonary embolism, lower pulmonary artery pressure, and increase arterial oxygenation 123. Five per cent of patients with acute pulmonary embolism will present with hemodynamic compromise with systolic blood pressure persistently less than 90 mm Hg; they represent the subgroup at the highest risk for early mortality from pulmonary embolism, thus standing to benefit the most from thrombolytic therapy 124.…”

“…The results of the International Cooperative Pulmonary Embolism Registry (ICOPER), showed no benefit in terms of 90 day mortality with thrombolytic therapy in hemodynamically unstable pulmonary embolism but should be interpreted with caution as only 32% of all such patients received thrombolysis and selection bias is likely present 124. A systematic review identified 18 randomized trials using thrombolytic therapy for the treatment of pulmonary embolism, including both hemodynamically stable and unstable pulmonary embolism 123. Overall a reduction in death with thrombolytic therapy was observed (odds ratio 0.51, 0.29 to 0.89; P=0.02; 1898 participants; low quality evidence), but this overall effect was lost when studies with a high risk of bias were excluded (odds ratio 0.66, 0.42 to 1.06; P=0.08; 2054 participants).…”