Abstract
Pulmonary thromboembolism (PTE) ranges from incidental, clinically unimportant thromboembolism to massive embolism with sudden death. Its treatment is well established in two groups of patients: heparin for those with normal systemic blood pressure without right ventricular dysfunction (RVD) and thrombolysis for those with RVD and circulatory shock. In an intermediate group of patients with systemic blood pressure stability combined with RVD, which is usually associated with worse outcome, the treatment is controversial. There are authors who strongly suggest thrombolysis while others contraindicate this procedure and recommend anticoagulation with heparin. This is a narrative review that includes clinical trials comparing thrombolysis and heparin for the treatment of PTE patients with systemic blood pressure stability and RVD published since 1973. The results show that there are only four trials on this subject with less than 500 patients. Many PTE patients with systemic blood pressure stability and RVD might benefit from thrombolysis but, on the other hand, the risk for hemorrhagic events may be increased. Large randomized clinical trials are required to clarify this.
Keywords: Systemic blood pressure, pulmonary thromboembolism, right ventricular dysfunction, treatment, thrombolysis
Current Respiratory Medicine Reviews
Title: Treatment of Pulmonary Thromboembolism in Patients with Systemic Blood Pressure Stability and Right Ventricular Dysfunction
Volume: 4 Issue: 1
Author(s): Thais Thomaz Queluz, Hugo Hyung Bok Yoo and Haroldo Rodrigues
Affiliation:
Keywords: Systemic blood pressure, pulmonary thromboembolism, right ventricular dysfunction, treatment, thrombolysis
Abstract: Pulmonary thromboembolism (PTE) ranges from incidental, clinically unimportant thromboembolism to massive embolism with sudden death. Its treatment is well established in two groups of patients: heparin for those with normal systemic blood pressure without right ventricular dysfunction (RVD) and thrombolysis for those with RVD and circulatory shock. In an intermediate group of patients with systemic blood pressure stability combined with RVD, which is usually associated with worse outcome, the treatment is controversial. There are authors who strongly suggest thrombolysis while others contraindicate this procedure and recommend anticoagulation with heparin. This is a narrative review that includes clinical trials comparing thrombolysis and heparin for the treatment of PTE patients with systemic blood pressure stability and RVD published since 1973. The results show that there are only four trials on this subject with less than 500 patients. Many PTE patients with systemic blood pressure stability and RVD might benefit from thrombolysis but, on the other hand, the risk for hemorrhagic events may be increased. Large randomized clinical trials are required to clarify this.
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Queluz Thomaz Thais, Bok Yoo Hyung Hugo and Rodrigues Haroldo, Treatment of Pulmonary Thromboembolism in Patients with Systemic Blood Pressure Stability and Right Ventricular Dysfunction, Current Respiratory Medicine Reviews 2008; 4 (1) . https://dx.doi.org/10.2174/157339808783497828
DOI https://dx.doi.org/10.2174/157339808783497828 |
Print ISSN 1573-398X |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6387 |
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