Successful thrombolytic therapy for massive pulmonary embolism.
The use and scope of thrombolytic therapy in the management of pulmonary embolism (PE) continues to evolve. The results of small studies suggest that thrombolytic therapy might have an impact on survival in massive PE with cardiogenic shock; however, no large studies to further this notion exist. Furthermore, the expanded application of thrombolytic therapy to patients with PE and right ventricular dysfunction (RVD) but without overt hemodynamic collapse remains controversial. We report successful use of the thrombolytic agent tissue plasminogen activator (tPA) in the management of life-threatening PE with RVD without overt cardiovascular collapse. We present evidence for the meritorious use of thrombolytic therapy in this category of PE patients. We believe that a broadened application of thrombolytic therapy to patients with PE and RVD but without cardiogenic shock, especially in younger patients, is beneficial and worth the risk.
Onuigbo
M
M
Department of Internal Medicine, Greater Baltimore Medical Center, MD 21204, USA.
Cuffy-Hallam
M
M
Mangano
A
A
Schwartz
M
M
Alikhan
M
M
D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010960:Plasminogen Activators / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000209:etiology; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014692:Ventilation-Perfusion Ratio; D018497:Ventricular Dysfunction, Right / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator