Thrombolysis in acute pulmonary embolism

SUMMARY OBJECTIVES Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.

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Main Authors: Bottega,Tiago Spiazzi, Vier,Marcele Gnata, Baldiaserotto,Hugo, Oliveira,Ellen Pierre de, Diaz,Claudia Liliana Moreno, Fernandes,Caio J.
Format: Digital revista
Language:English
Published: Associação Médica Brasileira 2020
Online Access:http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302020000300263
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spelling oai:scielo:S0104-423020200003002632020-05-29Thrombolysis in acute pulmonary embolismBottega,Tiago SpiazziVier,Marcele GnataBaldiaserotto,HugoOliveira,Ellen Pierre deDiaz,Claudia Liliana MorenoFernandes,Caio J. Pulmonary embolism Thrombolytic therapy Tissue plasminogen activator Ventricular dysfunction, right SUMMARY OBJECTIVES Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.info:eu-repo/semantics/openAccessAssociação Médica BrasileiraRevista da Associação Médica Brasileira v.66 n.3 20202020-03-01info:eu-repo/semantics/othertext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302020000300263en10.1590/1806-9282.66.3.263
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country Brasil
countrycode BR
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libraryname SciELO
language English
format Digital
author Bottega,Tiago Spiazzi
Vier,Marcele Gnata
Baldiaserotto,Hugo
Oliveira,Ellen Pierre de
Diaz,Claudia Liliana Moreno
Fernandes,Caio J.
spellingShingle Bottega,Tiago Spiazzi
Vier,Marcele Gnata
Baldiaserotto,Hugo
Oliveira,Ellen Pierre de
Diaz,Claudia Liliana Moreno
Fernandes,Caio J.
Thrombolysis in acute pulmonary embolism
author_facet Bottega,Tiago Spiazzi
Vier,Marcele Gnata
Baldiaserotto,Hugo
Oliveira,Ellen Pierre de
Diaz,Claudia Liliana Moreno
Fernandes,Caio J.
author_sort Bottega,Tiago Spiazzi
title Thrombolysis in acute pulmonary embolism
title_short Thrombolysis in acute pulmonary embolism
title_full Thrombolysis in acute pulmonary embolism
title_fullStr Thrombolysis in acute pulmonary embolism
title_full_unstemmed Thrombolysis in acute pulmonary embolism
title_sort thrombolysis in acute pulmonary embolism
description SUMMARY OBJECTIVES Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.
publisher Associação Médica Brasileira
publishDate 2020
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302020000300263
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