[Fibrinolysis in pulmonary embolism].
A POTENTIALLY FATAL CONDITION: Pulmonary embolism (PE) is a potentially fatal disorder for which heparin therapy improves the outcome. In spite of anticoagulation, mortality of PE remains high, especially when associated with shock or right ventricular dysfunction. THROMBOLYSIS: Indications of thrombolytic therapy in the treatment of PE remain relatively undefined. It is well established that thrombolytic therapy achieves a more rapid but not more complete dot lysis than heparin alone. RANDOMIZED STUDIES: Only one randomized add prospective study including 8 patients with massive PE associated with shock found a beneficial effect of thrombolysis treatment regarding mortality. The other studies which involved 453 patients did not find such a beneficial effect of thrombolysis on mortality. There is no convincing evidence suggesting beneficial effect of thrombolysis regarding PE recurrence or long term recovery. However, there is an increasing risk of major bleeding when using thrombolytic agents. In summary, thrombolytic therapy use should be restricted to patients who have hemodynamic instability in absence of absolute contraindications. A large-scale prospective randomized controlled trial, comparing heparin alone and thrombolysis therapy is needed to clarify the indications of these treatments.
Thabut
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Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 avenue du Général Lederc, F92110 Clichy. thabut@noos.fr
Jebrak
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D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000075202:Contraindications; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006439:Hemodynamics; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D013300:Streptokinase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator