title: Thrombolytic treatment (alteplase; rt-Pa) in acute massive pulmonary embolism and cardiopulmonary arrest.
abstract: Patients with pulmonary thromboembolism (PE) often decompensate suddenly, and once hemodynamic compromise has developed, mortality is extremely high. Currently, thrombolytic therapy for PE is still controversial. We retrospectively evaluated 34 patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease characteristics of patients who received thrombolytic treatment were retrospectively analyzed. The female to male ratio was 19/15 and the mean age was 63.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax computed tomography with echocardiography (32.4%). Twenty-two (64.7%) patients went into the cardiopulmonary arrest due to massive PE and 17 (50%) patients recovered without sequelae. Eleven (32.4%) patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. Alteplase (recombinant tissue plasminogen activator [rt-PA]) was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to rt-PA treatment complications. In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE. This thrombolytic treatment was not associated with any fatal hemorrhage complication. If there is any sign of acute PE, echocardiography should be used during cardiopulmonary arrest/instability. Alteplase should be given to patients with suspected massive PE.
authors: Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey.
authors: Adem
authors: A
authors: Dirican
authors: Department of Pulmonary Medicine, Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey.
authors: Sevket
authors: S
authors: Ozkaya
authors: Department of Cardiology, Medical Park Samsun Hospital, Samsun, Turkey.
authors: Ali Ekber
authors: AE
authors: Atas
authors: Department of Radiology, Medical Park Samsun Hospital, Samsun, Turkey.
authors: Esra Kayahan
authors: EK
authors: Ulu
authors: Department of Intensive Care Unit, Medical Park Samsun Hospital, Samsun, Turkey.
authors: Ilknur
authors: I
authors: Kitapci
authors: Department of Pulmonary Medicine, Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey.
authors: Ferah
authors: F
authors: Ece
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000378:metabolism*
chemical_list: D010959:Tissue Plasminogen Activator
keywords: cardiopulmonary arrest; hemorrhage; massive pulmonary embolism; mortality; resuscitation; rt-PA; thrombolytic treatment