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A Porcine Model of Acute Autologous Pulmonary Embolism
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Optimal Therapy for Unstable Pulmonary Embolism.

Paul D Stein1, James E Dalen2, Fadi Matta1

  • 1Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing.

The American Journal of Medicine
|October 6, 2018
PubMed
Summary

For unstable pulmonary embolism, thrombolytic therapy with an inferior vena cava (IVC) filter offers the lowest mortality. Early IVC filter insertion during instability significantly improves survival in all patients.

Keywords:
Inferior vena cava filtersMassive pulmonary embolismPulmonary embolismThrombolytic therapyUnstable pulmonary embolism

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Critical Care Medicine

Background:

  • Unstable pulmonary embolism (PE) lacks randomized controlled trials for key interventions.
  • Retrospective studies using administrative data are primary sources for treatment evidence.
  • Existing data suggest varied outcomes for thrombolysis, embolectomy, and IVC filters.

Purpose of the Study:

  • To evaluate the effectiveness of thrombolytic therapy, pulmonary embolectomy, and inferior vena cava (IVC) filters in unstable PE patients.
  • To determine the impact of IVC filter timing on mortality in unstable PE.
  • To identify optimal treatment strategies for unstable PE based on retrospective data.

Main Methods:

  • Analysis of retrospective cohort studies using large administrative databases.
  • Comparison of in-hospital all-cause mortality across different treatment strategies.
  • Assessment of outcomes based on the addition and timing of IVC filter insertion.

Main Results:

  • Thrombolytic therapy demonstrated the lowest in-hospital mortality.
  • Combining thrombolytic therapy with IVC filters further improved survival.
  • IVC filters reduced mortality when inserted on the day of admission or the next day during instability.

Conclusions:

  • The optimal treatment for unstable PE involves thrombolytic therapy and early IVC filter placement.
  • IVC filters are beneficial across all ages when administered during the critical unstable period.
  • This combined approach is indicated for all unstable pulmonary embolism patients regardless of age.