The role of vena caval interruption in the management of pulmonary embolism.
Sixty patients with documented moderate-to-severe pulmonary embolism have been managed primarily with anticoagulant or lytic-anticoagulant therapy during the past 6 years. The in-hospital mortality rate from embolization was 5 percent. Recurrent embolization was documented in only two patients (3 percent). Three patients (5 percent) required caval ligation because of a profound heparin sensitivity, peptic ulcer bleeding, and recurrent embolization while adequately anticoagulated. The study suggests that adequate anticoagulation is sufficient therapy for most patients and is associated with a low incidence of recurrent embolism. In view of the significant mortality rate reported following caval interruption and especially of the associated long-term venous sequelae, it is concluded that inferior vena caval interruption is seldom indicated in the management of pulmonary embolism and should be performed only when firm indications are present.
D000293:Adolescent; D000328:Adult; D000368:Aged; D004342:Drug Hypersensitivity; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007263:Infusions, Parenteral; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011877:Radionuclide Imaging; D012008:Recurrence; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014682:Vena Cava, Inferior / Q000601:surgery*; D014689:Venous Insufficiency / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use
D014859:Warfarin; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator