Document Detail

Thrombolytic therapy for acute pulmonary embolism: a critical appraisal.
MedLine Citation:
PMID:  19420199     Owner:  NLM     Status:  MEDLINE    
Pulmonary embolism (PE) is a prevalent condition that may account for > 300,000 deaths annually in the United States alone. Although thrombolytics have been studied as a treatment for acute PE since the 1960s, to date there have been only 11 randomized controlled trials comparing thrombolytic therapy to conventional anticoagulation, and the numbers of patients included in these trials has been small. Many studies confirm that thrombolytic therapy leads to rapid improvement in hemodynamic aberrations associated with PE, and this approach to massive PE with cardiogenic shock is a guideline-based practice. It is widely accepted that acute PE without associated right ventricular (RV) dysfunction or hemodynamic instability can be readily managed with standard anticoagulation. The appropriate therapy for submassive PE (PE associated with RV dysfunction but preserved systemic arterial BP) remains an area of contention, and definitive data proving mortality benefit in this setting are lacking. Further efforts at risk stratification may better determine who is in need of aggressive therapy. This article reviews historical aspects of and current evidence for thrombolytic therapy in acute PE with specific attention to bleeding risk, and data regarding hemodynamic parameters and mortality. We also discuss risk stratification techniques and propose a clinical algorithm for the incorporation of thrombolytic therapy.
Jamie L Todd; Victor F Tapson
Related Documents :
10073789 - Consultation before thrombolytic therapy in acute myocardial infarction. second nationa...
2507069 - Role of the general practitioner in managing patients with myocardial infarction: impac...
2916879 - Feasibility and safety of emergency interhospital transport of patients during early ho...
8924149 - Early management of acute myocardial infarction: thrombolysis, angioplasty, and adjunct...
9812079 - Prospective echocardiographic analysis of progressive obstruction of the proximal pulmo...
7775709 - Current issues concerning thrombolytic therapy for acute myocardial infarction.
8281539 - Cardiac involvement in rheumatoid arthritis: an echocardiographic study.
4068039 - Oxygen-mediated myocardial damage during ischaemia and reperfusion: role of the cellula...
20605699 - Soluble lectin-like oxidized ldl receptor-1 (slox-1) as a sensitive and specific biomar...
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Chest     Volume:  135     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-07     Completed Date:  2009-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1321-9     Citation Subset:  AIM; IM    
Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Pulmonary Embolism
Risk Assessment
Thrombolytic Therapy* / contraindications
Treatment Outcome

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

Previous Document:  Simulation system for a rebreathing technique to measure multiple cardiopulmonary function parameter...
Next Document:  Investigating the natural history of lung function: facts, pitfalls, and opportunities.