Liviu Macovei1, Razvan Mihai Presura, Catalina Arsenescu Georgescu. 1. Department of Cardiology, Cardiovascular Diseases Institute "Prof. Dr. George I M Georgescu", Romania University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania. liviughemacovei@yahoo.com.
Abstract
BACKGROUND AND AIM: High-risk pulmonary embolism (PE) represents an important health problem in emergency cardiology, being associated with a high rate of mortality. The aim of this study is to assess the efficacy and safety of pulmonary intra-arterial thrombolysis with streptokinase compared to systemic thrombolysis. METHODS AND RESULTS: In our study, 28 patients with acute high risk PE were treated by intra-arterial thrombolysis with clinical success rate of 96.4%, while in the group with systemic thrombolysis (24 patients) the rate of clinical success was significantly lower (70.8%). Also, pressure gradient between right ventricle (RV) and right atrial (RA) (PRV-RA) decreased significantly in patients treated by pulmonary intra-arterial thrombolysis instead of systemic thrombolysis. Mortality during the hospitalization was 0% in the group with local thrombolysis and 29.2% in the other group, with a significant statistical difference. Major bleeding complications appeared in 14.3% of the patients with local thrombolysis and in 20.8% of the ones treated by systemic thrombolysis, without statistical significance. Moreover, the proportion of minor bleeding was comparable in the two groups of patients. There was no intracranial bleeding. Disseminated intravascular coagulation occurred in 1 patient with systemic thrombolysis. CONCLUSIONS: The rate of clinical success and the regression of RV overload were significantly higher in patients treated by pulmonary intra-arterial thrombolysis. The results regarding the efficiency of the pulmonary intra-arterial thrombolysis in high-risk PE are encouraging, the mortality in these patients being significantly lower than the one for systemic administration of the thrombolytic agent.
RCT Entities:
BACKGROUND AND AIM: High-risk pulmonary embolism (PE) represents an important health problem in emergency cardiology, being associated with a high rate of mortality. The aim of this study is to assess the efficacy and safety of pulmonary intra-arterial thrombolysis with streptokinase compared to systemic thrombolysis. METHODS AND RESULTS: In our study, 28 patients with acute high risk PE were treated by intra-arterial thrombolysis with clinical success rate of 96.4%, while in the group with systemic thrombolysis (24 patients) the rate of clinical success was significantly lower (70.8%). Also, pressure gradient between right ventricle (RV) and right atrial (RA) (PRV-RA) decreased significantly in patients treated by pulmonary intra-arterial thrombolysis instead of systemic thrombolysis. Mortality during the hospitalization was 0% in the group with local thrombolysis and 29.2% in the other group, with a significant statistical difference. Major bleeding complications appeared in 14.3% of the patients with local thrombolysis and in 20.8% of the ones treated by systemic thrombolysis, without statistical significance. Moreover, the proportion of minor bleeding was comparable in the two groups of patients. There was no intracranial bleeding. Disseminated intravascular coagulation occurred in 1 patient with systemic thrombolysis. CONCLUSIONS: The rate of clinical success and the regression of RV overload were significantly higher in patients treated by pulmonary intra-arterial thrombolysis. The results regarding the efficiency of the pulmonary intra-arterial thrombolysis in high-risk PE are encouraging, the mortality in these patients being significantly lower than the one for systemic administration of the thrombolytic agent.
Authors: Ariel Izcovich; Juan M Criniti; Federico Popoff; Liming Lu; Jiaming Wu; Walter Ageno; Daniel M Witt; Michael R Jaff; Sam Schulman; Veena Manja; Peter Verhamme; Gabriel Rada; Yuqing Zhang; Robby Nieuwlaat; Wojtek Wiercioch; Holger J Schünemann; Ignacio Neumann Journal: Blood Adv Date: 2020-04-14
Authors: Miguel A De Gregorio; Jose A Guirola; Celia Lahuerta; Carolina Serrano; Ana L Figueredo; William T Kuo Journal: World J Radiol Date: 2017-07-28
Authors: Thomas L Ortel; Ignacio Neumann; Walter Ageno; Rebecca Beyth; Nathan P Clark; Adam Cuker; Barbara A Hutten; Michael R Jaff; Veena Manja; Sam Schulman; Caitlin Thurston; Suresh Vedantham; Peter Verhamme; Daniel M Witt; Ivan D Florez; Ariel Izcovich; Robby Nieuwlaat; Stephanie Ross; Holger J Schünemann; Wojtek Wiercioch; Yuan Zhang; Yuqing Zhang Journal: Blood Adv Date: 2020-10-13
Authors: Claire S Whyte; Hadj Ahmed Mostefai; Kim M Baeten; Andrew J Lucking; David E Newby; Nuala A Booth; Nicola J Mutch Journal: Int J Mol Sci Date: 2021-02-20 Impact factor: 6.208