Systemic Fibrinolytic Therapy in the Presence of Absolute Contraindication; a Case Series (original) (raw)
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Expanding the discussion on fibrinolytic contraindications
Journal of Experimental and Clinical Medicine, 2021
The European Resuscitation Council Guidelines recommend the administration of fibrinolytic therapy when acute pulmonary embolism is a known or suspected cause of cardiac arrest. However, contraindications that limit the use of fibrinolytics are sometimes challenged by clinicians, including head trauma in the previous three weeks. We report on the successful use of rescue fibrinolytic therapy on a patient with acute head trauma who had a cardiac arrest in the emergency department as a result of a pulmonary embolism (PE). To the best of our knowledge, this is the first case of successful fibrinolytic therapy for a patient with acute head trauma in the literature.
Clinical and Experimental Emergency Medicine, 2022
Objective We aimed to determine the effect of fibrinolytic therapy on hemodynamic parameters at 4 hours after treatment and bleeding complications in patients with intermediate- and high-risk pulmonary embolism.Methods This single-center, retrospective, cohort study included patients with intermediate- and high-risk pulmonary embolism treated with fibrinolytics. Their demographic and clinical characteristics, complications, and vital signs at the initiation of and 4 hours after fibrinolytic therapy were evaluated. The primary outcome was the change in the patients’ vital signs at 4 hours after fibrinolytic therapy, compared by the Mann-Whitney U-test.Results Seventy-nine patients were included in this study. The systolic and diastolic blood pressures of the high-risk group at 4 hours after fibrinolytic therapy were higher than those at the initiation of fibrinolytic therapy (80 mmHg vs. 99 mmHg, P = 0.029; 49 mmHg vs. 67 mmHg, P = 0.011, respectively). In the intermediate-risk group...
Fibrinolytic Treatment for Pulmonary Thromboembolism: A Systematic Review
Clinics of Oncology , 2024
Pulmonary embolism is a relatively common cardiovascular emergency involving occlusion of the pulmonary vascular bed, which can lead to life-threatening right ventricular failure [1]. In addition, venous thromboembolism, clinically presented as deep vein thrombosis or pulmonary embolism, is the third most frequent acute cardiovascular syndrome globally, second only to acute myocardial infarction and stroke [2,3]. In addition, this disease is often linked to persistent dyspnea and poor physical capacity 6 months to 3 years after an acute episode 4.
Two-edged Knife: Massive Pulmonary Embolism and Thrombolytic Contraindication
Journal of Emergency Medicine Case Reports, 2020
İntroduction: Pulmonary embolism is a common cause of death among emergency department admissions, and it has a high mortality and morbidity rate. Etiological reasons are generally associated with immobility. Radiological imaging methods are at the forefront in diagnosis. Anticoagulant and thrombolytic therapy may be preferred in treatment according to the hemodynamic condition of the patient. Case report: A 56-year-old female patient admitted to the emergency department with sudden onset of dyspnea and syncope with a condition of cardiogenic shock, and echocardiography revealed an enlargement of the right heart chambers and impaired functions, and a tomography was performed with the pre-diagnosis of pulmonary embolism. When systemic thrombolytic therapy was contraindicated in the patient who had embolism on tomography, catheter-based thrombectomy and selective low-dose thrombolytic therapy to the pulmonary artery were administered. The patient, who became hemodynamically stable and...
Pharmaceuticals
Pulmonary thromboembolism is a very common cardiovascular disease, with a high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. The heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decisions surrounding this therapeutic regimen also represent a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate–high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except...
Interventional treatment of pulmonary embolism - where do we currently stand?
Bulgarian Cardiology
Acute pulmonary embolism is the third most common cause of cardiovascular mortality in the world. The sudden pressure overload of the right ventricle, caused by the thrombotic masses in the pulmonary artery, may quickly progress to profound cardiogenic shock. That results in a mortality rate of more than 50% in patients with a massive form of pulmonary embolism. In such cases, systemic fibrinolysis is warranted, which leads to rapid improvement of the right ventricular function and hemodynamic stabilization. The thrombolytic effect of systemic fibrinolysis is, unfortunately, accompanied by an almost 5 times increased risk of bleeding, especially intracranial one. Therefore, in most cases, for patients with uncompromised hemodynamics, only anticoagulation treatment is offered. Interventional treatment of acute pulmonary embolism consists of the usage of very low-dose fibrinolytic devices or percutaneous thrombus aspiration devices. The goal is to provide rapid removal of the thrombot...
Srpski arhiv za celokupno lekarstvo
Introduction/Objective. Patients with submassive (intermediate risk) pulmonary embolism (PE) represent a very heterogeneous group, whose therapeutic strategy still questions whether some groups of patients would have net clinical benefit from fibrinolytic therapy (FT). Methods. From the institutional pulmonary embolism registry, 116 patients with submassive PE were identified, and the relation of their outcome to FT was analyzed using the propensity score (PS) adjustment. The primary endpoint was the composite of death, in-hospital cardiopulmonary deterioration, or recurrence of PE. Safety outcomes were updated TIMI non-CABG related major and minor bleeding. Results. According to Cox regression analysis, the incidence of composite endpoint was significantly lower in patients treated with FT compared to anticoagulant therapy (AT) only (PS adjusted HR 0.22; 95% CI 0.05?0.89; p = 0.039). But, when patients were stratified into four PS quartiles, only patients in the highest PS quartile...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2014
Massive pulmonary embolism is associated with mortality rates exceeding 50%. Current practice guidelines include the immediate administration of thrombolytic therapy in the absence of contraindications. However, thrombolysis for pulmonary embolism is said to be absolutely contraindicated in the presence of recent hemorrhagic stroke and other conditions. The current contraindications to thrombolytic therapy have been extrapolated from data on acute coronary syndrome and are not specific for venous thromboembolic disease. Some investigators have proposed that the current contraindications be viewed as relative, rather than absolute, in cases of high-risk pulmonary embolism. We present the case of a 60-year-old woman in whom massive pulmonary embolism led to cardiac arrest with pulseless electrical activity. Eight weeks earlier, she had sustained a hemorrhagic cerebrovascular accident-a classic absolute contraindication to thrombolytic therapy. Despite this practice guideline, we admin...