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Thrombolytic treatment (alteplase; rt-Pa) in acute massive pulmonary embolism and cardiopulmonary arrest.

Dirican A, Ozkaya S, Atas AE, Ulu EK, Kitapci I, Ece F - Drug Des Devel Ther (2014)

Bottom Line: In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE.This thrombolytic treatment was not associated with any fatal hemorrhage complication.Alteplase should be given to patients with suspected massive PE.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey.

ABSTRACT
Patients with pulmonary thromboembolism (PE) often decompensate suddenly, and once hemodynamic compromise has developed, mortality is extremely high. Currently, thrombolytic therapy for PE is still controversial. We retrospectively evaluated 34 patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease characteristics of patients who received thrombolytic treatment were retrospectively analyzed. The female to male ratio was 19/15 and the mean age was 63.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax computed tomography with echocardiography (32.4%). Twenty-two (64.7%) patients went into the cardiopulmonary arrest due to massive PE and 17 (50%) patients recovered without sequelae. Eleven (32.4%) patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. Alteplase (recombinant tissue plasminogen activator [rt-PA]) was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to rt-PA treatment complications. In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE. This thrombolytic treatment was not associated with any fatal hemorrhage complication. If there is any sign of acute PE, echocardiography should be used during cardiopulmonary arrest/instability. Alteplase should be given to patients with suspected massive PE.

No MeSH data available.


Related in: MedlinePlus

A 43-year-old woman admitted to the hospital presenting with acute dyspnea, tachycardia, and hypotension.Notes: The echocardiography images show the marked (dotted lines) acute enlargement of the right atrium and right ventricle with hypokinetic right ventricular wall, interventricular septal shift towards the left ventricle and tricuspid valvular insufficiency with pulmonary hypertension (A). Normal right heart function was seen after 24 hours of treatment with alteplase (B).
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f3-dddt-8-759: A 43-year-old woman admitted to the hospital presenting with acute dyspnea, tachycardia, and hypotension.Notes: The echocardiography images show the marked (dotted lines) acute enlargement of the right atrium and right ventricle with hypokinetic right ventricular wall, interventricular septal shift towards the left ventricle and tricuspid valvular insufficiency with pulmonary hypertension (A). Normal right heart function was seen after 24 hours of treatment with alteplase (B).

Mentions: A total of 34 patients were diagnosed and treated with rt-PA because of massive PE. The characteristics of the patients and treatment results are presented in Table 1. The female to male ratio was 19/15 and the mean age was 6 3.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax CT with echocardiography (32.4%) (Figures 1,2,3, and 4). Twenty-two (64.7%) patients went into cardiopulmonary arrest due to massive PE and 17 (50%) of total patients recovered without sequelae. The most common finding was tachycardia in all patients with massive PE. Eleven (32.4%) of patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. rt-PA was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to any complication of the rt-PA treatment.


Thrombolytic treatment (alteplase; rt-Pa) in acute massive pulmonary embolism and cardiopulmonary arrest.

Dirican A, Ozkaya S, Atas AE, Ulu EK, Kitapci I, Ece F - Drug Des Devel Ther (2014)

A 43-year-old woman admitted to the hospital presenting with acute dyspnea, tachycardia, and hypotension.Notes: The echocardiography images show the marked (dotted lines) acute enlargement of the right atrium and right ventricle with hypokinetic right ventricular wall, interventricular septal shift towards the left ventricle and tricuspid valvular insufficiency with pulmonary hypertension (A). Normal right heart function was seen after 24 hours of treatment with alteplase (B).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061167&req=5

f3-dddt-8-759: A 43-year-old woman admitted to the hospital presenting with acute dyspnea, tachycardia, and hypotension.Notes: The echocardiography images show the marked (dotted lines) acute enlargement of the right atrium and right ventricle with hypokinetic right ventricular wall, interventricular septal shift towards the left ventricle and tricuspid valvular insufficiency with pulmonary hypertension (A). Normal right heart function was seen after 24 hours of treatment with alteplase (B).
Mentions: A total of 34 patients were diagnosed and treated with rt-PA because of massive PE. The characteristics of the patients and treatment results are presented in Table 1. The female to male ratio was 19/15 and the mean age was 6 3.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax CT with echocardiography (32.4%) (Figures 1,2,3, and 4). Twenty-two (64.7%) patients went into cardiopulmonary arrest due to massive PE and 17 (50%) of total patients recovered without sequelae. The most common finding was tachycardia in all patients with massive PE. Eleven (32.4%) of patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. rt-PA was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to any complication of the rt-PA treatment.

Bottom Line: In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE.This thrombolytic treatment was not associated with any fatal hemorrhage complication.Alteplase should be given to patients with suspected massive PE.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey.

ABSTRACT
Patients with pulmonary thromboembolism (PE) often decompensate suddenly, and once hemodynamic compromise has developed, mortality is extremely high. Currently, thrombolytic therapy for PE is still controversial. We retrospectively evaluated 34 patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease characteristics of patients who received thrombolytic treatment were retrospectively analyzed. The female to male ratio was 19/15 and the mean age was 63.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax computed tomography with echocardiography (32.4%). Twenty-two (64.7%) patients went into the cardiopulmonary arrest due to massive PE and 17 (50%) patients recovered without sequelae. Eleven (32.4%) patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. Alteplase (recombinant tissue plasminogen activator [rt-PA]) was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to rt-PA treatment complications. In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE. This thrombolytic treatment was not associated with any fatal hemorrhage complication. If there is any sign of acute PE, echocardiography should be used during cardiopulmonary arrest/instability. Alteplase should be given to patients with suspected massive PE.

No MeSH data available.


Related in: MedlinePlus