Thrombolysis in Angiographically Proved Intermediate to High Risk Pulmonary Embolism

Area of Science:

• Cardiology
• Pulmonology
• Emergency Medicine

Background:

• Pulmonary embolism (PE) is a critical emergency.
• Anticoagulant therapy is standard, but high-risk patients with right ventricular dysfunction have increased mortality.
• Thrombolytic therapy may improve outcomes in this subgroup.

Purpose of the Study:

• To evaluate the effectiveness of thrombolytic therapy in patients with angiographically confirmed pulmonary embolism and right ventricular dysfunction.
• To assess changes in pulmonary artery pressures and identify potential complications.

Main Methods:

• Systemic workup for suspected PE, including Wells score and d-dimer assay.
• Echocardiography to identify right ventricular dysfunction.
• Pulmonary arteriography for diagnosis, followed by thrombolysis for confirmed PE.
• Repeat angiography to assess treatment efficacy and hemodynamic changes.

Main Results:

• Twenty-seven patients with confirmed PE underwent thrombolysis.
• Angiographic success was achieved in 81.5% of patients (22/27).
• Significant reductions in systolic and mean pulmonary artery pressures were observed post-thrombolysis. One in-hospital mortality occurred during treatment, with no major bleeding complications.

Conclusions:

• Thrombolysis is an effective treatment for pulmonary embolism with right ventricular dysfunction.
• The risk of major bleeding complications associated with thrombolysis in this patient group is low.