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. 2017 Feb;9(2):163-169.
doi: 10.14740/jocmr2829w. Epub 2016 Dec 31.

Efficacy and Safety of Thrombolytic Therapy in Acute Submassive Pulmonary Embolism: Follow-Up Study

Santosh Kumar Sinha  1 , Mohit Sachan  1 , Amit Goel  1 , Karandeep Singh  1 , Vikas Mishra  1 , Mukesh Jitendra Jha  1 , Ashutosh Kumar  1 , Nasar Abdali  1 , Mohammad Asif  1 , Mahamdula Razi  1 , Umeshwar Pandey  1 , Ramesh Thakur  1 , Chandra Mohan Varma  1 , Vinay Krishna  1
Affiliations

Efficacy and Safety of Thrombolytic Therapy in Acute Submassive Pulmonary Embolism: Follow-Up Study

Santosh Kumar Sinha et al. J Clin Med Res. 2017 Feb.

Abstract

Background: Thrombolysis in acute submassive pulmonary embolism (PE) remains controversial. So we studied impact of thrombolytic therapy in acute submassive PE in terms of mortality, hemodynamic status, improvement in right ventricular function, and safety in terms of major and minor bleeding.

Method: A single-center, prospective, randomized study of 86 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. Patients received thrombolysis (single bolus of tenecteplase) with unfractionated heparin (UFH, group I) or placebo with UFH (group II).

Result: Mean age of patients was 54.35 ± 12.8 years with male dominance (M:F = 70%:30%). Smoking was the most common risk factor seen in 29% of all patients, followed by recent history of immobilization (25%), history of surgery or major trauma within past 1 month (15%), dyslipidemia (10%) and diabetes mellitus (10%). Dyspnea was the most common symptom in 80% of all patients, followed by chest pain in 55% and syncope in 6%. Primary efficacy outcome occurred significantly better in group I vs. group II (4.5% vs. 20%; P = 0.04), and significant difference was also found in hemodynamic decompensation (4.5% vs. 20%; P = 0.04), the fall in mean pulmonary artery systolic pressure (PASP) (28.8% vs. 22.5%; P = 0.03), improvement in right ventricular (RV) function (70% vs. 40%; P = 0.001) and mean hospital stay (8.1 ± 2.5 vs. 11.1 ± 2.14 days; P = 0.001). There was no difference in mortality and major bleeding as safety outcome but increased minor bleeding occurred in group I patients (16% vs. 12%; P = 0.04).

Conclusion: Patients with acute submassive PE do not derive overall mortality benefit, recurrent PE and rehospitalization with thrombolytic therapy but had improved clinical outcome in form of decrease in hemodynamic decompensation, mean hospital stay, PASP and improvement of RV function with similar risk of major bleed but at cost of increased minor bleeding.

Keywords: Hemodynamic decompensation; Pulmonary artery systolic pressure; Right ventricular function; Submassive pulmonary embolism; Tenecteplase; Thrombolysis.

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Figures

Figure 1
Figure 1
Transthoracic 2D echocardiogram images showing RV dilatation and dysfunction along with thrombus in a patient with acute pulmonary embolism (arrow showing thrombus in short axis view).
Figure 2
Figure 2
Contrast-enhanced computed tomography of pulmonary vasculature showing large saddle thrombus in right pulmonary artery (red arrow).
See this image and copyright information in PMC

References

    1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet. 1999;353(9162):1386–1389. doi: 10.1016/S0140-6736(98)07534-5. - DOI - PubMed
    1. Fanikos J, Piazza G, Zayaruzny M, Goldhaber SZ. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost. 2009;102(4):688–693. doi: 10.1160/th09-04-0266. - DOI - PubMed
    1. Mehta NJ, Jani K, Khan IA. Clinical usefulness and prognostic value of elevated cardiac troponin I levels in acute pulmonary embolism. Am Heart J. 2003;145(5):821–825. doi: 10.1016/S0002-8703(02)94704-6. - DOI - PubMed
    1. Pacouret G, Schellenberg F, Hamel E, Charbonnier B, Mouray H. [Troponin I in massive acute pulmonary embolism: results of a prospective series] Presse Med. 1998;27(32):1627. - PubMed
    1. Grifoni S, Olivotto I, Cecchini P, Pieralli F, Camaiti A, Santoro G, Conti A. et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101(24):2817–2822. doi: 10.1161/01.CIR.101.24.2817. - DOI - PubMed

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