Thrombolysis in acute pulmonary embolism
Carregando...
Citações na Scopus
1
Tipo de produção
article
Data de publicação
2020
Título da Revista
ISSN da Revista
Título do Volume
Editora
ASSOC MEDICA BRASILEIRA
Autores
BOTTEGA, Tiago Spiazzi
VIER, Marcele Gnata
BALDIASEROTTO, Hugo
Citação
REVISTA DA ASSOCIACAO MEDICA BRASILEIRA, v.66, n.3, p.263-267, 2020
Resumo
OBJECTIVES: Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS: Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS: The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION: Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.
Palavras-chave
Pulmonary embolism, Thrombolytic therapy, Tissue plasminogen activator, Ventricular dysfunction right
Referências
- Casella IB, 2015, REV ASSOC MED BRAS, V61, P44, DOI 10.1590/1806-9282.61.01.044
- Fernandes CJCS, 2019, J BRAS PNEUMOL, V45
- Fernandes CJCD, 2018, J BRAS PNEUMOL, V44, P237, DOI [10.1590/s1806-37562017000000204, 10.1590/S1806-37562017000000204]
- Fernandes CJCD, 2017, J BRAS PNEUMOL, V43, P403, DOI [10.1590/S1806-37562017000060002, 10.1590/s1806-37562017000060002]
- Fernandes CJCD, 2016, J BRAS PNEUMOL, V42, P146, DOI [10.1590/S1806-37562016042020068, 10.1590/S1806-37562016000000068]
- Fernandes CJ, 2019, RESPIRATION, V98, P253, DOI 10.1159/000501342
- Fernandes CJ, 2019, EUR RESPIR REV, V28, DOI 10.1183/16000617.0119-2018
- Gavilanes-Oleas FA, 2018, CLINICS, V73, DOI 10.6061/clinics/2018/e216
- Girardi Adriana M, 2018, J Intensive Care Med, p885066618816280, DOI 10.1177/0885066618816280
- Heit JA, 2015, NAT REV CARDIOL, V12, P464, DOI 10.1038/nrcardio.2015.83
- Kearon C, 2016, CHEST, V149, P315, DOI 10.1016/j.chest.2015.11.026
- Konstantinides SV, 2017, J AM COLL CARDIOL, V69, P1536, DOI 10.1016/j.jacc.2016.12.039
- Konstantinides SV, 2014, EUR HEART J, V35, P3033, DOI 10.1093/eurheartj/ehu283
- Meyer G, 2014, NEW ENGL J MED, V370, P1402, DOI 10.1056/NEJMoa1302097
- Miranda CH, 2019, J BRAS PNEUMOL, V45, DOI 10.1590/1806-3713/e20180297
- Rocha ATC, 2010, REV ASSOC MED BRAS, V56, P197, DOI 10.1590/S0104-42302010000200019
- Soriano LD, 2019, J BRAS PNEUMOL, V45, DOI 10.1590/1806-3713/e20170251
- Stein PD, 2012, AM J MED, V125, P465, DOI 10.1016/j.amjmed.2011.10.015
- Xu QX, 2015, J THORAC DIS, V7, P810, DOI 10.3978/j.issn.2072-1439.2015.04.51