title: Medical compared with surgical treatment for massive pulmonary embolism.
abstract: We compared embolectomy (when available) with thrombolysis in patients with shock and massive pulmonary embolism. 13 patients were operated on, 10 (77%) of whom survived. The inferior vena cava was routinely clipped. The 24 medically treated patients were given alteplase until systemic and pulmonary artery pressures stabilised and heparin thereafter; 16 (67%) survived. Major haemorrhage occurred in 28% of medically treated patients, but was not fatal. 1 patient had a small cerebral haemorrhage that resolved without drainage. One-fifth of the medical group had a re-embolism, which suggests that temporary caval umbrellas are indicated in medically treated patients. Thrombolysis may provide a life-saving option and a randomised trial is warranted.
authors.affiliation: Department of Medicine, University of Hannover, Germany.
authors.forename: D C
authors.initials: DC
authors.lastname: Gulba
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.forename: H G
authors.initials: HG
authors.lastname: Borst
authors.forename: P
authors.initials: P
authors.lastname: Lichtlen
authors.forename: R
authors.initials: R
authors.lastname: Dietz
authors.forename: F C
authors.initials: FC
authors.lastname: Luft
mesh_terms: D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery
chemical_list: D006493:Heparin; D010959:Tissue Plasminogen Activator