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Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism

Meneveau, Nicolas ; Seronde, Marie-France ; Blonde, Marie-Cecile ; Legalery, Pierre ; Didier-Petit, Katy ; Briand, Florent ; Caulfield, Fiona ; Schiele, Frančois ; Bernard, Yvette ; Bassand, Jean-Pierre

Chest, 2006-04, Vol.129 (4), p.1043-1050 [Periódico revisado por pares]

Northbrook, IL: Elsevier Inc

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Título:
Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism
Autor: Meneveau, Nicolas ; Seronde, Marie-France ; Blonde, Marie-Cecile ; Legalery, Pierre ; Didier-Petit, Katy ; Briand, Florent ; Caulfield, Fiona ; Schiele, Frančois ; Bernard, Yvette ; Bassand, Jean-Pierre
Assuntos: Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cardiology. Vascular system ; Care and treatment ; Diagnosis ; Embolectomy ; embolism ; Female ; Fibrinolytic Agents - therapeutic use ; Heart failure ; Humans ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Pneumology ; Prospective Studies ; Pulmonary arteries ; Pulmonary embolism ; Pulmonary Embolism - drug therapy ; Pulmonary Embolism - surgery ; Pulmonary embolisms ; Pulmonary hypertension ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Retreatment ; Streptokinase - therapeutic use ; surgery ; thrombolysis ; Thrombolytic Therapy ; Tissue Plasminogen Activator - therapeutic use ; Treatment Failure
É parte de: Chest, 2006-04, Vol.129 (4), p.1043-1050
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SourceType-Scholarly Journals-1
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Descrição: The management of patients with acute massive pulmonary embolism (PE) who do not respond to fibrinolytic therapy remains unclear. We aimed to compare rescue surgical embolectomy and repeat thrombolysis in patients who did not respond to thrombolysis. We conducted a prospective single-center registry of PE patients who underwent thrombolytic therapy. Lack of response to thrombolysis within the first 36 h was prospectively defined as both persistent clinical instability and residual echocardiographic right ventricular dysfunction. Patients underwent surgical embolectomy or repeat thrombolysis, at the discretion of the attending physician. The clinical end point was a combined end point including recurrent PE, bleeding complications, or PE-related death, which was defined as death from recurrent PE or cardiogenic shock. Long-term adverse outcomes included death, recurrent thromboembolic events, and congestive heart failure. From January 1995 to January 2005, 488 PE patients underwent thrombolysis, of whom 40 (8.2%) did not respond to thrombolysis. Fourteen patients were treated by rescue surgical embolectomy, and 26 were treated by repeat thrombolysis. There was no significant difference in baseline characteristics between the two groups. The in-hospital course was uneventful in 11 of the surgically treated patients (79%) and in 8 patients (31%) treated by repeat thrombolysis (p = 0.004). There was a trend for higher mortality in the medical group than in the surgical group (10 vs 1 deaths, respectively; p = 0.07). There were significantly more recurrent PEs (fatal and nonfatal) in the repeat-thrombolysis group (35% vs 0%, respectively; p = 0.015). While no significant difference was observed in number of major bleeding events, all bleeding events in the repeat-thrombolysis group were fatal. The rate of uneventful long-term evolution was the same in the two groups. Rescue surgical embolectomy led to a better in-hospital course when compared with repeat thrombolysis in patients with massive PE who have not responded to thrombolysis. The transfer of patients who have not responded to thrombolysis to tertiary cardiac surgery centers could be considered as an alternative option.
Editor: Northbrook, IL: Elsevier Inc
Idioma: Inglês

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Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism

Meneveau, Nicolas ; Seronde, Marie-France ; Blonde, Marie-Cecile ; Legalery, Pierre ; Didier-Petit, Katy ; Briand, Florent ; Caulfield, Fiona ; Schiele, Frančois ; Bernard, Yvette ; Bassand, Jean-Pierre

Northbrook, IL: Elsevier Inc

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