Medicine of the Future in America

Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism: Long-term Evolution of Patients Who Survived the Acute Phase

Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism: Long-term Evolution of Patients Who Survived the Acute PhaseComparatively, only one patient (7%) died following rescue surgical embolectomy, from refractory cardiogenic shock (p = 0.07). The rate of fatal or nonfatal recurrent PE was significantly higher in patients who underwent repeat thrombolysis compared with those who were operated on (35% vs 0%, respectively; p = 0.015). review
Eight patients (20%) experienced bleeding complications, with no significant difference between the two treatment groups. All four major bleeding episodes that occurred in the repeat fibrinolysis group were fatal. Intracranial hemorrhage occurred in one patient (4%) after undergoing repeat thrombolysis. The majority of major bleeding episodes were related to an early invasive procedure (pulmonary angiography, two patients; venous puncture site, one patient; or insertion of intracaval device, one patient). One patient experienced severe GI bleeding. Surgical control of hematoma and blood transfusion were needed in two and four patients, respectively.

Long-term follow-up data were obtained in all patients who survived the acute phase. The mean follow-up period was 5.7 ± 2.7 years (range, 2.6 to 10.5 years). Long-term condition evolution was uneventful in 62% of patients who underwent rescue embolectomy compared with 69% of those who underwent repeat thrombolysis. The difference was not statistically significant. Of the 29 patients who were alive after the hospital stay, 4 patients died during follow-up from comorbidities. In the repeat-thrombolysis group, one patient died from cancer and one patient died from postoperative complications, while two patients died in the surgical group, one from cancer and one from renal failure. The rate of thromboembolic events (ie, recurrent PE or deep vein thrombosis [DVT]) was 23% in patients who had undergone surgical embolectomy and was 25% in those treated by repeat thrombolysis (p = 0.98), even though approximately half of the study population was permanently treated with oral anticoagulant therapy. The occurrence of CHF or change in NYHA functional class to class III or IV was similar in both groups. All in all, the rate of uneventful evolution was the same in the two groups.

This entry was posted in Pulmonary function and tagged embolism, surgery, thrombolysis.
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