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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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Local Thrombolysis in High-Risk Pulmonary Embolism-13 Years Single-Center Experience
Liviu Macovei1,2, Razvan Mihai Presura1, Robert Magopet1
1"Prof. Dr. George I. M. Georgescu" 433412Cardiovascular Diseases Institute Iaşi, Romania.
Summary
Local thrombolysis significantly reduced in-hospital mortality for high-risk pulmonary embolism patients compared to systemic thrombolysis. Long-term outcomes for pulmonary hypertension were also better with local treatment.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Interventional Radiology
Background:
- High-risk pulmonary embolism (PE) poses a significant mortality risk.
- Systemic thrombolysis is a standard treatment but carries risks.
- Local thrombolysis offers a potential alternative for targeted treatment.
Purpose of the Study:
- To compare the prognosis of local thrombolysis versus systemic thrombolysis in high-risk PE patients.
- To evaluate in-hospital and long-term outcomes, including mortality and residual pulmonary hypertension.
Main Methods:
- Observational study over 13 years.
- Included 37 patients treated with local thrombolysis and 36 with systemic thrombolysis (streptokinase).
- Assessed cardiogenic shock, right ventricle-right atrium pressure gradient, bleeding complications, in-hospital mortality, and 24-month survival and pulmonary hypertension.
Main Results:
- Complete remission of cardiogenic shock observed in the local thrombolysis group (P = .002).
- Significantly lower in-hospital mortality in the local thrombolysis group (P = .003).
- Better 24-month follow-up of right ventricle-right atrium pressure gradient and improved evolution of residual pulmonary hypertension after local thrombolysis.
Conclusions:
- Local thrombolysis is associated with lower in-hospital mortality in high-risk PE patients compared to systemic thrombolysis.
- Local thrombolysis demonstrates superior long-term outcomes regarding residual pulmonary hypertension.
- Bleeding complications and 24-month survival rates were comparable between the two treatment groups.
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