From the Guidelines
Thrombolytic therapy is recommended for patients with high-risk pulmonary embolism (PE) as it leads to faster improvements in pulmonary obstruction, pulmonary artery pressure (PAP), and pulmonary vascular resistance (PVR), with a significant reduction in the combined outcome of mortality and recurrent PE, as shown in a meta-analysis of thrombolysis trials 1. The European Society of Cardiology (ESC) guidelines support the use of systemic thrombolytic therapy in patients with high-risk PE, defined as those with cardiogenic shock and/or persistent arterial hypotension 1. Key points to consider when administering thrombolytic therapy include:
- The greatest benefit is observed when treatment is initiated within 48 hours of symptom onset, but thrombolysis can still be useful in patients who have had symptoms for 6-14 days 1
- Unsuccessful thrombolysis, as judged by persistent clinical instability and unchanged right ventricular (RV) dysfunction on echocardiography after 36 hours, has been reported in 8% of high-risk PE patients 1
- A meta-analysis of thrombolysis trials indicated a significant reduction in the combined outcome of mortality and recurrent PE, with a 9.9% rate of severe bleeding and a 1.7% rate of intracranial hemorrhage 1
- In normotensive patients with intermediate-risk PE, defined as the presence of RV dysfunction and elevated troponin levels, thrombolytic therapy was associated with a significant reduction in the risk of hemodynamic decompensation or collapse, but this was paralleled by an increased risk of severe extracranial and intracranial bleeding 1 The 2019 ESC guidelines also recommend anticoagulation with unfractionated heparin, low molecular weight heparin (LMWH), or fondaparinux for patients with non-high-risk PE, with thrombolytic therapy considered in selected patients with intermediate-risk PE 1. Overall, the decision to administer thrombolytic therapy should be based on individual patient risk factors, including the presence of high-risk or intermediate-risk PE, and the potential benefits and risks of treatment.
From the Research
Moped Pulmonary Embolism Thrombolysis Study Resume
There are no research papers to assist in answering this question as the term "moped pulmonary embolism thrombolysis study" is not found in the provided evidence. However, the following information is available on pulmonary embolism thrombolysis:
Pulmonary Embolism Thrombolysis
- Thrombolytic therapy can be life-saving in patients with high-risk pulmonary embolism (PE) 2
- Patients with PE and systemic arterial hypotension should receive thrombolytic therapy unless severe contraindications are present 2
- Thrombolysis is the mainstay of therapy in high-risk pulmonary embolism 3
- The efficacy and safety of different thrombolytic agents in the treatment of acute PE have been evaluated in a Bayesian network meta-analysis 4
Thrombolytic Agents
- Four thrombolytic agents (alteplase, reteplase, streptokinase, and urokinase) appeared to be superior in efficacy compared with anticoagulants alone due to a reduction in mortality and no increase in bleeding risk 4
- Alteplase may be a better choice because it not only reduced mortality but also reduced PE recurrence rate and treated pulmonary artery systolic pressure (PASP) 4
- Tenecteplase did not reduce mortality compared with anticoagulants alone and may not be a good choice of thrombolytic agent due to an increase in minor bleeding compared with streptokinase and anticoagulants alone 4
Risk Stratification
- Risk stratification is now oriented toward evaluation of the risk of early pulmonary embolism-related death 3
- Patients with a high probability of PE should undergo chest imaging, and D-dimer testing is not necessary 5
- Patients with a low or intermediate clinical probability of PE can be evaluated using a structured score or clinical gestalt, and D-dimer testing can be used to exclude PE 5