title: Systemic or local thrombolysis in high-risk pulmonary embolism.
abstract: OBJECTIVE
  High-risk pulmonary embolism (PE) represents an important health problem in emergency cardiology, being associated with a high rate of mortality. The aim of this study is to assess the efficacy and safety of pulmonary intra-arterial thrombolysis with streptokinase compared to systemic thrombolysis.
  
  
  RESULTS
  In our study, 28 patients with acute high risk PE were treated by intra-arterial thrombolysis with clinical success rate of 96.4%, while in the group with systemic thrombolysis (24 patients) the rate of clinical success was significantly lower (70.8%). Also, pressure gradient between right ventricle (RV) and right atrial (RA) (PRV-RA) decreased significantly in patients treated by pulmonary intra-arterial thrombolysis instead of systemic thrombolysis. Mortality during the hospitalization was 0% in the group with local thrombolysis and 29.2% in the other group, with a significant statistical difference. Major bleeding complications appeared in 14.3% of the patients with local thrombolysis and in 20.8% of the ones treated by systemic thrombolysis, without statistical significance. Moreover, the proportion of minor bleeding was comparable in the two groups of patients. There was no intracranial bleeding. Disseminated intravascular coagulation occurred in 1 patient with systemic thrombolysis.
  
  
  CONCLUSIONS
  The rate of clinical success and the regression of RV overload were significantly higher in patients treated by pulmonary intra-arterial thrombolysis. The results regarding the efficiency of the pulmonary intra-arterial thrombolysis in high-risk PE are encouraging, the mortality in these patients being significantly lower than the one for systemic administration of the thrombolytic agent.
authors.affiliation: Department of Cardiology, Cardiovascular Diseases Institute "Prof. Dr. George I M Georgescu", Romania University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania. liviughemacovei@yahoo.com.
authors.forename: Liviu
authors.initials: L
authors.lastname: Macovei
authors.forename: Razvan Mihai
authors.initials: RM
authors.lastname: Presura
authors.forename: Catalina
authors.initials: C
authors.lastname: Arsenescu Georgescu
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012383:Romania; D013300:Streptokinase / Q000008:administration & dosage* / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase