Treatment of Unstable Pulmonary Embolism in the Elderly and Those with Comorbid Conditions

Stein, Paul D.; Matta, Fadi

doi:10.1016/j.amjmed.2012.12.007

Cited by 33 publications

(18 citation statements)

References 24 publications

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“…19 The risk of bleeding with fibrinolysis, particularly of intracranial hemorrhage, increases when treating elderly individuals. 9,10 Factors that contribute to increased bleeding in elderly patients who receive thrombolysis include higher rates of hypertension, 20 hepatic or renal insufficiency, 21,22 diabetes, 22,23 antiplatelet utilization, 24 and lower weight. 25,26 We observed a higher prescription of antiplatelet therapy before the procedure in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Despite these findings, its utilization remains low, particularly among elderly patients, owing to concerns of increased bleeding, specifically intracranial hemorrhage (ICH). 1,9,10 The overall risk of bleeding increases incrementally by 4% with each year of age. 10 The risk of ICH appears to be significantly greater in the elderly population >75 years old, which has been considered a relative contraindication for the administration of systemic fibrinolysis in recent guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with pulmonary embolism: A SEATTLE II sub-analysis

et al. 2017

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Elderly patients with acute pulmonary embolism (PE) have higher mortality than non-elderly patients, but receive systemic fibrinolysis less frequently. In this sub-analysis of the SEATTLE II trial, we evaluated the efficacy and safety of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with submassive and massive PE. We compared patients ⩾65 years old with those <65 years old. Eligible patients had proximal PE and a right ventricular-to-left ventricular (RV/LV) diameter ratio ⩾0.9 on chest computed tomography (CT). The primary efficacy outcome was the change in chest CT-measured RV/LV diameter ratio at 48 hours after procedure initiation. The primary safety outcome was major bleeding within 72 hours. Sixty-two patients were ⩾65 years of age and 88 were <65 years of age. The RV/LV diameter ratio decreased in both groups 48 hours post-procedure, with a mean change of -0.47 in those ⩾65 and -0.39 in those <65 years old, with no difference between groups ( p = 0.31). Major bleeding occurred in nine (15%) of those ⩾65 and in six (7%) of those <65 years old ( p = 0.17). Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis resulted in a similar reduction in RV/LV diameter ratio in elderly patients with massive and submassive PE compared with non-elderly patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with pulmonary embolism: A SEATTLE II sub-analysis

et al. 2017

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“…Despite the inconsistent results of controlled clinical trials, one observational study of 72,230 unstable patients with acute PE revealed that thrombolytic therapy was associated with lower all-cause mortality when compared with no treatment (15 vs. 47%, respectively) and lower mortality attributable to PE when compared with no treatment (8.4 vs. 42%) ( 10 ). However, observational results obtained from the same population revealed that thrombolytic therapy was underutilized and less likely to be administered in older patients (aged >60 years) and in patients with comorbid conditions, highlighting a possible lack of confidence exhibited by clinicians regarding the use of thrombolytic therapy ( 11 ). While the reported effect size is large in the two above-mentioned studies, the observational design and the potential influence of bias demonstrates that the efficacy of thrombolytic therapy in this clinical setting remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Low-dose tissue plasminogen activator in the treatment of a massive pulmonary thromboembolism in a colon cancer patient treated with bevacizumab: A case report

2014

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The current study describes the fibrinolytic treatment of a patient exhibiting an acute massive pulmonary thromboembolism, who was also receiving a bevacizumab-based combination regimen for metastatic colon cancer. The administration of bevacizumab has been associated with an increased risk of venous thromboembolic events and bleeding in cancer patients. However, there is insufficient data regarding the safety and activity of thrombolytic agents in cancer patients receiving bevacizumab-based therapy. In the present case, despite the increased risk of bleeding, low-dose and prolonged tissue plasminogen activator infusion was effectively and reliably applied to treat a massive pulmonary embolism, which resulted in hemodynamic instability in the patient.

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“…A pesar de la falta de datos, en un estudio observacional de 72.230 pacientes con embolia pulmonar e inestabilidad hemodinámica se encontró que el tratamiento fibrinolítico estaba asociado con menores tasas de mortalidad por todas las causas (15 % con trombólisis Vs. 47 % sin trombólisis) y, tambien, en la mortalidad atribuible a embolia pulmonar (8,4 % Vs. 42 %) (38). Sin embargo, los datos posteriores de la misma poblacion mostraron que el tratamiento trombolítico fue subutilizado y menos administrado en pacientes mayores de 60 años y en aquellos con comorbilidades, destacándose la falta de uniformidad en las indicaciones (39). Debido a que el tamaño del efecto informado fue grande en ambos estudios, se sugiere que el tratamiento trombolítico en esta entidad mejora la supervivencia y disminuye complicaciones como la hipertensión pulmonar.…”

Section: Trombólisis En Tromboembolia Pulmonarunclassified

Trombólisis

Acosta¹,

Sáenz²,

Bonilla³

et al. 2018

Rev. salud. bosque.

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En la homeostasis de un individuo sano se desarrollan coágulos para prevenir la pérdida de sangre, pero las fallas del equilibrio hemostático pueden ocasionar obstrucción aguda de una arteria como fenómeno fisiopatológico principal, que puede beneficiarse del tratamiento trombolítico que consiste en la administración, por vía endovenosa o en ocasiones intraarterial, de medicamentos capaces de destruir los coágulos de fibrina y permitir que se restaure el flujo sanguíneo en el vaso sanguíneo. Esto se hace para evitar complicaciones como infarto cerebral, embolia pulmonar, trombosis venosa profunda e infarto agudo del miocardio.El siguiente documento es una revisión bibliográfica de la terapia fibrinolitica y su uso en estas entidades, teniendo en cuenta las recomendaciones de la Agency for Healthcare Research and Quality (AHRQ), usando PubMed como base datos de búsqueda principal. Se obtuvieron artículos sobre trombólisis en infarto agudo del miocardio, trombembolismo pulmonar y accidente cerebrovascular y según la pertinencia se procedió a su análisis para generar una recomendación.

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Treatment of Unstable Pulmonary Embolism in the Elderly and Those with Comorbid Conditions

Cited by 33 publications

References 24 publications

Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with pulmonary embolism: A SEATTLE II sub-analysis

Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis in elderly patients with pulmonary embolism: A SEATTLE II sub-analysis

Low-dose tissue plasminogen activator in the treatment of a massive pulmonary thromboembolism in a colon cancer patient treated with bevacizumab: A case report

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