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Thrombolysis

  • Chapter
Management of Acute Pulmonary Embolism

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Clinically stable patients without major comorbidity, who receive anticoagulant treatment for pulmonary embolism (PE), have a low in-hospital mortality rate ranging between 1 and 2%. In contrast, more than 25% of patients with massive PE, defined by persistently low blood pressure or shock at presentation, die during the first 2 wk after diagnosis. Available evidence indicates that thrombolytic treatment reduces the mortality risk in these patients, who, however, represent only 4.5% of all patients admitted to the hospital for PE. Further data support the notion that normotensive patients with submassive PE, defined by the presence of right ventricular dysfunction detected on echocardiography or indicated by elevated cardiac biomarkers, may also have a higher mortality risk than patients with normal right ventricular function. These patients may represent more than 20% of all patients admitted to the hospital for acute PE. Indirect evidence suggests that thrombolytic treatment may reduce the mortality rate in these patients, but the available controlled studies were not powerful enough to confirm or refute this hypothesis. A large randomized controlled trial is urgently needed to resolve this issue. Recombinant tissue-type plasminogen activator, given as a 100-mg dose over 2h, is the most systematically studied thrombolytic regimen for patients with acute PE. It acts faster than regimens using urokinase or streptokinase, and should be considered as the reference thrombolytic treatment for patients with PE.

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Author information

Authors and Affiliations

  1. Faculté de Médecine, Université Paris-Descartes, and Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Guy Meyer MD

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  1. Guy Meyer MD
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Editors and Affiliations

  1. Department of Cardiology and Pulmonology, Georg August University, Goettingen, Germany

    Stavros V. Konstantinides MD (Professor of Medicine) (Professor of Medicine)

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© 2007 Humana Press Inc., Totowa, NJ

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Meyer, G. (2007). Thrombolysis. In: Konstantinides, S.V. (eds) Management of Acute Pulmonary Embolism. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-287-8_10

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  • DOI: https://doi.org/10.1007/978-1-59745-287-8_10

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-644-3

  • Online ISBN: 978-1-59745-287-8

  • eBook Packages: MedicineMedicine (R0)

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