Treatment Difficulties in High Risk Pulmonary Embolism. A Case Report

Balázs Bajka; Edvin Benedek; Alexandra Stănescu; Emese Rapolti; Monica Chițu; István Kovács

doi:10.1515/jce-2016-0007

.blurhash-client-img { display: none !important; }

Treatment Difficulties in High Risk Pulmonary Embolism. A Case Report

Journal of Cardiovascular Emergencies

Volume 2 (2016): Issue 1 (March 2016)

By: Balázs Bajka, Edvin Benedek, Alexandra Stănescu, Emese Rapolti, Monica Chițu and István Kovács

Open Access

|Jun 2016

Abstract

Pulmonary embolism (PE) remains a common and potentially life-threatening cardiovascular emergency. Systemic thrombolysis with intravenous infusion of a thrombolytic agent is generally recommended for treatment of high risk PE. However, this method has known limitations in the presence of high bleeding risk. Catheter-directed thrombolysis has the potential to achieve the same benefits as systemic thrombolysis, with a lower risk of haemorrhage. The case presented is of a 67-year-old male patient with a high risk of pulmonary embolism and contraindications for systemic thrombolysis, in whom the presence of severe comorbidities presented an increased risk of surgical embolectomy, who was successfully treated by catheter-directed thrombolysis.

References

1. Goldhaber SZ. Pulmonary Embolism. N Engl J Med. 1998;339:93-104.10.1056/NEJM199807093390207
Search in Google Scholar
2. Goldhaber SZ. Thrombolysis for pulmonary embolism. N Engl J Med. 2002;347:1131-1132. doi:10.1016/0033-0620(91)90009-B.10.1016/0033-0620(91)90009-B
Search in Google Scholar
3. Fiumara K, Kucher N, Fanikos J, Goldhaber SZ. Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol. 2006;97:127-129. doi: http://dx.doi.org/10.1016/j.amjcard.2005.07.117.10.1016/j.amjcard.2005.07.117
Search in Google Scholar
4. Goldhaber SZ, Haire WD, Feldstein ML, et al. Alteplase versus heparin in acute pulmonary embolism: randomized trial assessing right ventricular function and pulmonary perfusion. Lancet. 1993;341:507-511. doi:10.1016/0140-6736(93)90274-K.10.1016/0140-6736(93)90274-K
Search in Google Scholar
5. Konstantinides S, Tiede N, Kasper W, et al. Comparison of alteplase versus heparin for resolution of major pulmonary embolism. Am J Cardiol. 1998;82(8):966-970. doi: http://dx.doi.org/10.1016/S0002-9149(98)00513-X.10.1016/S0002-9149(98)00513-X
Search in Google Scholar
6. Fukuda I, Taniguchi S, Suzuki Y, et al. Improved outcome of surgical pulmonary embolectomy by aggressive intervention for critically ill patients. Ann Thorac Surg. 2011;91(3):728-732. doi: 10.1016/j.athoracsur.2010.10.086.10.1016/j.athoracsur.2010.10.086
Search in Google Scholar
7. Kuo WT, Gould MK, Hofmann LV, et al. Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques. J Vasc Interv Radiol. 2009;20(11):1431-1440. doi: 10.1016/j. jvir.2009.08.002.
Search in Google Scholar
8. Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial. Lancet. 1960;1(7138):1309-1312.
Search in Google Scholar
9. Kanter DS, Mikkola KM, Goldhaber SZ, et al. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest. 1997;111(5):1241-1245. doi:10.1378/chest.111.5.124110.1378/chest.111.5.1241
Search in Google Scholar
10. Levine MN, Goldhaber SZ, Califf RM, et al. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism. Chest. 1995;108(4 Suppl):291S-301S.10.1378/chest.108.4_Supplement.291S
Search in Google Scholar
11. Mikkola KM, Patel SR, Goldhaber SZ, et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J. 1997;134(1):69-72. doi: http://dx.doi.org/10.1016/S0002-8703(97)70108-X.10.1016/S0002-8703(97)70108-X
Search in Google Scholar
12. Sharifi M, Bay C, Mehdipour M. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial). Am J Cardiol. 2013;111(2):273-7. doi: 10.1016/j.amjcard.2012.09.027.10.1016/j.amjcard.2012.09.02723102885
Search in Google Scholar
13. Wang C, Zhai Z, Shen YH, et al. Efficacy and safety of low dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboembolism: a randomized, multicenter, controlled trial. Chest. 2010;137(2):254-62. doi: 10.1378/chest.09-0765.10.1378/chest.09-0765712699419741062
Search in Google Scholar
14. Engelberger RP, Kucher N, et al. Ultrasound-assisted thrombolysis for acute pulmonary embolism: a systematic review. Eur Heart J. 2014;35:758-764. doi: http://dx.doi.org/10.1093/eurheartj/ehu029.10.1093/eurheartj/ehu02924497337
Search in Google Scholar
15. Kucher N, Boekstegers P, Baumgartner I, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circ. 2014;129(4):479-86. doi: 10.1161/CIRCULATIONAHA.113.005544.10.1161/CIRCULATIONAHA.113.00554424226805
Search in Google Scholar

Articles in this issue

DOI: https://doi.org/10.1515/jce-2016-0007 | Journal eISSN: 2457-5518 | Journal ISSN: 2457-550X

Journal RSS Feed

Language: English

Page range: 37 - 42

Submitted on: Oct 15, 2015

Accepted on: Jan 17, 2016

Published on: Jun 3, 2016

Published by: Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Related subjects:

Emergency medicine and intensive-care medicine,

Radiology

© 2016 Balázs Bajka, Edvin Benedek, Alexandra Stănescu, Emese Rapolti, Monica Chițu, István Kovács, published by Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 2 (2016): Issue 1 (March 2016)