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Hannah Eberle, Raquel Lyn, Tamara Knight, Emily Hodge, Mitchell Daley
PURPOSE: Current literature on clinical controversies surrounding the use of thrombolytic agents in patients with intermediate-risk pulmonary embolism (PE) is reviewed. SUMMARY: PE is a major cause of morbidity and mortality. When used in conjunction with anticoagulation, thrombolysis has been shown to reduce hemodynamic decompensation in select patients, but thrombolytic therapy is associated with high risks of bleeding and intracranial hemorrhage and its role in treating patients with intermediate-risk PE remains controversial...
June 12, 2018: American Journal of Health-system Pharmacy: AJHP
Frederikus A Klok, Walter Ageno, Stefano Barco, Harald Binder, Benjamin Brenner, Daniel Duerschmied, Klaus Empen, Pompilio Faggiano, Joachim H Ficker, Nazzareno Galiè, Alexandre Ghuysen, Matthias Held, Nadine Heydenreich, Menno V Huisman, David Jiménez, Matija Kozak, Irene M Lang, Mareike Lankeit, Thomas Münzel, Antoniu Petris, Piotr Pruszczyk, Kurt Quitzau, Sebastian Schellong, Kai-Helge Schmidt, Branislav S Stefanovic, Franck Verschuren, Anamaria Wolf-Puetz, Guy Meyer, Stavros V Konstantinides
Patients with intermediate-risk pulmonary embolism (PE) may, depending on the method and cut-off values used for definition, account for up to 60% of all patients with PE and have an 8% or higher risk of short-term adverse outcome. Although four non-vitamin K-dependent direct oral anticoagulants (NOACs) have been approved for the treatment of venous thromboembolism, their safety and efficacy as well as the optimal anticoagulation regimen using these drugs have not been systematically investigated in intermediate-risk PE...
December 2017: Thrombosis and Haemostasis
Nicoletta Riva, Livia Puljak, Lorenzo Moja, Walter Ageno, Holger Schünemann, Nicola Magrini, Alessandro Squizzato
OBJECTIVE: To explore disagreements in multiple systematic reviews (SRs) assessing the benefit-to-harm ratio of thrombolytic therapy in patients with intermediate-risk pulmonary embolism (PE). STUDY DESIGN AND SETTING: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Database of Abstracts and Reviews of Effectiveness were searched up to April 14, 2016. We included SRs and guidelines that evaluated thrombolytic therapy, compared with anticoagulation alone, in intermediate-risk PE...
May 2018: Journal of Clinical Epidemiology
Samuel Z Goldhaber
No abstract text is available yet for this article.
March 28, 2017: Journal of the American College of Cardiology
Stavros V Konstantinides, Eric Vicaut, Thierry Danays, Cecilia Becattini, Laurent Bertoletti, Jan Beyer-Westendorf, Helene Bouvaist, Francis Couturaud, Claudia Dellas, Daniel Duerschmied, Klaus Empen, Emile Ferrari, Nazzareno Galiè, David Jiménez, Maciej Kostrubiec, Matija Kozak, Christian Kupatt, Irene M Lang, Mareike Lankeit, Nicolas Meneveau, Massimiliano Palazzini, Piotr Pruszczyk, Matteo Rugolotto, Aldo Salvi, Olivier Sanchez, Sebastian Schellong, Bozena Sobkowicz, Guy Meyer
BACKGROUND: The long-term effect of thrombolytic treatment of pulmonary embolism (PE) is unknown. OBJECTIVES: This study investigated the long-term prognosis of patients with intermediate-risk PE and the effect of thrombolytic treatment on the persistence of symptoms or the development of late complications. METHODS: The PEITHO (Pulmonary Embolism Thrombolysis) trial was a randomized (1:1) comparison of thrombolysis with tenecteplase versus placebo in normotensive patients with acute PE, right ventricular (RV) dysfunction on imaging, and a positive cardiac troponin test result...
March 28, 2017: Journal of the American College of Cardiology
Gerold Söffker, Stefan Kluge
Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed...
January 2015: Deutsche Medizinische Wochenschrift
Gianfranco Alunni, Daniele Coen
No abstract text is available yet for this article.
November 2014: Giornale Italiano di Cardiologia
Menno V Huisman, Anne J Fogteloo, Frederikus A Klok
International guidelines suggest that patients presenting with acute pulmonary embolism should be given routine thrombolysis on top of heparin. There is debate as to whether patients with acute pulmonary embolism who present in a haemodynamically stable condition, yet have signs of right ventricular dysfunction and increased troponin, actually need thrombolytic therapy. The results of the Pulmonary Embolism Thrombolysis study (PEITHO) show that in this particular patient group routine thrombolysis led to less haemodynamic decompensation or collapse, but that this advantage came with significantly higher incidences of haemorrhagic stroke and major extracranial bleeding...
2014: Nederlands Tijdschrift Voor Geneeskunde
S Konstantinides, M Lankeit
Management of acute pulmonary embolism (PE) has advanced considerably in the past year, and progress is expected to continue in 2013. To help determine the optimal management strategy for normotensive patients with intermediate-risk PE, the Pulmonary Embolism Thrombolysis (PEITHO) study completed enrolment of 1006 patients with evidence of right ventricular dysfunction (by echocardiography or computed tomography) plus a positive troponin test. Patients have been randomised to thrombolytic treatment with tenecteplase versus placebo, and the effects on clinical end points (death or haemodynamic collapse) assessed at 7 and 30 days...
2013: Hämostaseologie
(no author information available yet)
BACKGROUND: In acute pulmonary embolism (PE), overt right ventricular (RV) failure with cardiogenic shock indicates a poor prognosis. However, normotensive patients with acute RV dysfunction on echocardiography or computed tomography and with myocardial troponin elevation may also have an adverse outcome. Thrombolysis rapidly reverses RV pressure overload in PE, but it remains unclear whether it may improve the early and long-term clinical outcome of selected normotensive patients. DESIGN: The Pulmonary EmbolIsm THrOmbolysis (PEITHO) trial is a prospective, multicenter, international, randomized (1:1), double-blind comparison of thrombolysis with tenecteplase vs placebo in normotensive patients with confirmed PE, an abnormal right ventricle on echocardiography or computed tomography, and a positive troponin I or T test result...
January 2012: American Heart Journal
G Meyer
No abstract text is available yet for this article.
December 2008: Revue de Pneumologie Clinique
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