RT Book, Section
A1 Beri, Samarth
A1 Pastores, Stephen M.
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136418266
T1 Thrombolytic Therapy for Submassive Pulmonary Embolism
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136418266
RD 2024/04/24
AB KEY  POINTSAcute  pulmonary  embolism  (PE)  is  the  most  frequent  and  potentially  fatal  venous  thromboembolic  event.Clinically,  acute  PE  can  be  classified  as  either  massive  or  submassive.  Thrombolytic  therapy  is  the  recommended  treatment  for  patients  with  acute  massive  PE  who  are  hemodynamically  unstable  and  do  not  have  a  high  bleeding  risk.In  patients  with  submassive  PE,  the  use  of  thrombolytic  therapy  remains  controversial.Risk  stratification  with  echocardiography  may  assist  when  deciding  to  use  thrombolytic  therapy  for  hemodynamically  stable  patients  with  submassive  PE  and  evidence  of  right  ventricular  (RV)  dysfunction.Echocardiographic  findings  in  patients  with  acute  PE  include  RV  hypokinesis  and  dilatation,  interventricular  septal  flattening  and  paradoxical  motion  toward  the  left  ventricle,  tricuspid  regurgitation,  pulmonary  hypertension  and  loss  of  inspiratory  collapse  of  the  inferior  vena  cava.The  hemodynamic  status  of  the  patient  with  acute  PE  is  the  most  significant  predictor  of  mortality  in  the  short  term.Among  patients  with  submassive  PE  being  treated  with  unfractionated  heparin,  the  administration  of  tenecteplase  reduced  the  composite  endpoint  of  all-cause  mortality  or  hemodynamic  decompensation  at  7  days  when  compared  to  placebo  but  was  associated  with  an  increased  rate  of  bleeding.