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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, November 8, 2015

Trombolisis en Embolismo pulmonar

Resultado de imagen de JAMA
Saurav C y col. JAMA. 2014;311(23):2414-2421. doi:10.1001/jama.2014.5990.
"Pulmonary embolism (PE) is an important cause of morbidity and mortality with more than 100 000 US cases annually and as many as 25% of patients presenting with sudden death. Pulmonary embolism is associated with increased mortality rates for up to 3 months after the index PE event. Multiple studies and meta-analyses have evaluated the role of thrombolytic therapy in PE with largely discordant results. A randomized trial from 2002 showed improvements in a combined end point of in-hospital mortality and hemodynamic deterioration requiring escalation of treatment but did not have sufficient statistical power to assess differences in mortality or intracranial hemorrhage (ICH). Meta-analyses have also been underpowered to assess the association of thrombolytic therapy with mortality. Subsequent observational data have suggested both benefits and underuse of thrombolytic therapy in patients with high-risk PE.
More recent consensus guidelines have cited a pressing need for outcomes data regarding thrombolytics from contemporary trials, especially in hemodynamically stable patients with evidence of right ventricular (RV) dysfunction (intermediate-risk PE). Several recent trials have evaluated the role of thrombolytics in PE for these patients without definitive results, particularly for the end point of mortality. Thus, we performed a meta-analysis of all randomized trials of thrombolytic therapy in PE. We aimed to ascertain associations of thrombolytic therapy with bleeding risk and potential mortality benefits, with special attention paid to the subpopulation of patients presenting with intermediate-risk PE.
Thrombolytic therapy was associated with lower all-cause mortality in patients with PE, including the subset of patients with hemodynamically stable PE associated with RV dysfunction. The associated risks of major bleeding and ICH were significantly elevated with thrombolytic therapy, although there may be reduced harm in patients younger than 65 years. Results reported here should not be construed to apply to patients with low-risk PE."