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Cardiologia Croatica, Vol. 17 No. 9-10, 2022.

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https://doi.org/10.15836/ccar2022.292

Systemic thrombolytic therapy in patients with intermediate-high-risk pulmonary embolism

Karlo Golubić orcid id orcid.org/0000-0003-0684-6333
Nikola Kos orcid id orcid.org/0000-0001-8829-2543
Tonći Batinić orcid id orcid.org/0000-0002-8431-6963
Mislav Vrsalović

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Abstract

Keywords

pulmonary embolism; thrombolytic therapy

Hrčak ID:

289805

URI

https://hrcak.srce.hr/289805

Publication date:

8.12.2022.

Visits: 484 *

Copyright: 2022, Croatian Cardiac Society

Date received: 04 November 2022

Date accepted: 10 November 2022

Publication date (print and electronic): November 2022

Volume: 17

Issue: 9-10

Page: 292

Publisher ID: CC 2022 17_9-10_292

DOI: 10.15836/ccar2022.292

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Acute and intensive cardiology

KEYWORDS: :

KEYWORDS:

Keyword: pulmonary embolism

Keyword: thrombolytic therapy

Systemic thrombolytic therapy in patients with intermediate-high-risk pulmonary embolism

[https://orcid.org/0000-0003-0684-6333] Karlo Golubić[*]

[https://orcid.org/0000-0001-8829-2543] Nikola Kos

[https://orcid.org/0000-0002-8431-6963] Tonći Batinić

[https://orcid.org/0000-0002-8432-404X] Mislav Vrsalović

 

Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Karlo Golubić, Klinički bolnički centar Sestre milosrdnice, Vinogradska cesta 29, HR-10000 Zagreb, Croatia. / Phone: +385-99-3787-165 / E-mail: karlo.golubic@kbcsm.hr

Pulmonary embolism remains the one of the commonest cardiovascular disease, the severity of which is variable and can be lethal. The incidence is expected to increase due to the aging population. Intermediate-high risk pulmonary embolism is characterized by hemodynamical stability, but elevated mortality risk and both radiographic and laboratory signs of right heart strain. Thrombolysis remains a possible life saving treatment option but bears an increased risk of potentially life-threatening hemorrhage. Optimal treatment is still not established. (1-3) We present a series of intermediate-high risk patients treated in our hospital with thrombolytic therapy (n=4, 2 male, median age 58.5) and compare relevant direct and indirect values of right ventricular load before and after treatment (Table 1). We also provide a summary of our clinical approach in light of current guidelines and two meta-analyses.

TABLE 1 Comparison of relevant direct and indirect values of right ventricular load before and after treatment.
Before treatmentAfter treatment
SO2 (%)TnI (ng/L)NTproBNP (ng/L)SO2 (%)TnI (ng/L)NTproBNP (ng/L)
806576103983583
8261352292<10145
841909122972622976
94125259796<10139

LITERATURE

1 

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 January 21;41(4):543–603. https://doi.org/10.1093/eurheartj/ehz405 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/31504429

2 

Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014 June 18;311(23):2414–21. https://doi.org/10.1001/jama.2014.5990 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/24938564

3 

Zuo Z, Yue J, Dong BR, Wu T, Liu GJ, et al. Thrombolytic therapy for pulmonary embolism. Cochrane Database Syst Rev. 2021 April 15;4(4):CD004437. https://doi.org/10.1002/14651858.CD004437.pub6 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/33857326

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