Document Detail


Christchurch experience of pulmonary embolism with and without thrombolysis.
MedLine Citation:
PMID:  20953221     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Thrombolysis for normotensive patients with large clot burden pulmonary embolism remains debatable. We aim to document our current management of pulmonary embolism, examining determinants of therapy and outcomes. METHOD: A retrospective chart-based review of all patients admitted with pulmonary embolism under Cardiology service in Christchurch Hospital between 2002-2007. All related CT pulmonary angiograms were also reviewed for quantification of clot burden and evidence of right ventricular strain. RESULTS: 120 patients were admitted during the audit period. Hypotensive patients had a significantly higher troponin level and Qanadli scores. RV/LV ratio >1 in CTPA was 80% sensitive and 57% specific in predicting RV strain on echocardiogram. Forty-six patients were thrombolysed, most with large clot burden and right ventricular strain. No treatment related death or intracranial haemorrhages occurred; however six patients required blood transfusion and six patients had persistent pulmonary hypertension at 6 months. There was a higher in-patient event rate in thrombolysed group, due to increased bleeding, compared to non-thrombolysed patients. CONCLUSION: Thrombolysis was successfully performed with relatively low in-patient and 6-month event rate. Long term advantage over routine anticoagulation was not demonstrated. The role of thrombolysis in normotensive patients with large clot burden remains uncertain. CTPA markers of RV strain correlated well with echocardiography.
Authors:
Wandy Chan; Tiffany Campbell; Sharyn MacDonald; Ian Crozier
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-10-15
Journal Detail:
Title:  The New Zealand medical journal     Volume:  123     ISSN:  1175-8716     ISO Abbreviation:  N. Z. Med. J.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-18     Completed Date:  2010-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401067     Medline TA:  N Z Med J     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  41-9     Citation Subset:  IM    
Affiliation:
Cardiology Department, Christchurch Public Hospital, Christchurch, New Zealand. wandyc@cdhb.govt.nz
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiography
Cardiology Service, Hospital*
Female
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
New Zealand / epidemiology
Prognosis
Pulmonary Embolism / drug therapy*,  epidemiology,  radiography
Retrospective Studies
Survival Rate / trends
Thrombolytic Therapy / methods*,  utilization
Young Adult
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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