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Thrombolytic therapy for venous thromboembolism. Utilization by practicing pulmonologists
L A Witty1, A Krichman, V F Tapson
1Division of Allergy, Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC.
Archives of Internal Medicine
|July 25, 1994
Summary
Pulmonary physicians strongly favor thrombolytic therapy for massive pulmonary embolism (PE) with hypotension. They also favor its use in severe hypoxemia or deep venous thrombosis (DVT) under specific conditions, indicating a need for further trials.
Area of Science:
- Cardiology
- Pulmonology
- Vascular Medicine
Background:
- Pulmonary embolism (PE) is a life-threatening condition where thrombolytic therapy use is debated.
- Deep venous thrombosis (DVT) causes morbidity and can lead to PE.
Purpose of the Study:
- To determine current practices of pulmonary physicians regarding thrombolytic therapy for PE and DVT.
- To assess physician considerations for using thrombolytic agents in various clinical scenarios.
Main Methods:
- A questionnaire was sent to 100 pulmonary physicians in 10 southeastern states.
- Physicians' practice settings and case volumes of PE and DVT were recorded.
- Physicians were surveyed on their likelihood to use thrombolytic therapy in specific PE and DVT situations.
Main Results:
- Responses were received from 56 physicians; 70% were in private practice.
- 54% of physicians had used thrombolytic agents for acute PE, versus 28% for DVT.
- All physicians favored thrombolytic therapy for massive PE with hypotension; 73% would strongly consider it for acute PE with severe hypoxemia.
Conclusions:
- Pulmonary physicians strongly support thrombolytic therapy for massive PE with hypotension.
- A majority favor thrombolytic use for PE with severe hypoxemia or proximal DVT within 7 days.
- Further randomized trials are needed to refine therapeutic strategies for venous thromboembolism.