title: Alteplase treatment of acute pulmonary embolism in the intensive care unit.
abstract: Acute pulmonary embolism accounts for 50 000 to 100 000 deaths each year in the United States. Because of the wide spectrum of clinical manifestations, ranging from massive pulmonary embolism to small peripheral emboli, stratifying and treating patients according to their signs and symptoms is important when an acute embolism is suspected. Patients' clinical findings can range from no signs or symptoms to unstable hemodynamic status and shock. The 3-month mortality is 10% to 15%, but can be as high as 60% in patients with hemodynamic shock. This article reviews the classifications of acute peripheral emboli, explains the treatment of acute peripheral emboli, reviews the pharmacology of alteplase, and presents an assessment of the literature evaluating alteplase for the treatment of acute peripheral emboli. Clinical pearls for the administration, monitoring, and care of a patient receiving alteplase in an intensive care unit also are discussed.
authors.affiliation: University of Pittsburgh School of Pharmacy, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh PA 15213, USA. smithburgerpl@upmc.edu
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Smithburger
authors.forename: Shauna
authors.initials: S
authors.lastname: Campbell
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane-Gill
mesh_terms: D000208:Acute Disease; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007362:Intensive Care Units; D015201:Meta-Analysis as Topic; D008991:Monitoring, Physiologic / Q000451:nursing; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator