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

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My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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lunes, 30 de mayo de 2016

Controversies of Thrombolytics for PE

emDocs - May 28, 2016 - Author: Long B - Edited by: Santistevan J and Koyfman A
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"Pulmonary embolism (PE) is a disease with significant morbidity and mortality, with an annual incidence of 100,000 cases in the U.S. which increases with age, from 1 per 1500 in early life to 1 in 300 per year above age 80 years. As providers know, the clinical presentation varies, with up to 25% of patients experiencing sudden death, while other patients with large thrombus burden experiencing few symptoms...
The benefits of thrombolysis is established for massive pulmonary embolism, but the use of thrombolytics for submassive PE is controversial in the literature due to different definitions of submassive PE, different outcomes and definitions of benefit, and the risk of life threatening hemorrhage. Thrombolytic use may reduce intravascular thrombus size and pulmonary resistance; however, there is risk of major bleeding, including intracerebral hemorrhage (ICH). Thus, the conundrum for physicians and patients...
Summary
  • Submassive PE presents a challenge for physicians. Current literature including meta-analyses have inconsistent definitions of submassive PE, lack functional outcomes, have differing primary outcomes and assessments, and use different treatment protocols with thrombolytics and anticoagulation agents.
  • Support exists for improvement in long-term outcomes with thrombolytics, with increased risk of major bleeding in high-risk patients.
  • The risks and benefits of thrombolytic treatment should be considered on a case-by-case basis.
  • Shared decision-making with the patient discussing the risks and benefits of treatment is recommended.
  • Further studies that assess risk stratification, functional outcomes, and treatment protocols with thrombolytic dosing are needed."