Relation of Duration of Symptoms With Response to Thrombolytic Therapy in Pulmonary Embolism
Section snippets
Methods
Data from 5 multicenter trials of thrombolytic therapy for PE1, 2, 3, 4, 5, 6, 7that occurred between 1985 and 1994 were combined to create the database used in this overview. Of the 373 patients, 55 in the fourth trial were excluded from this analysis because they were randomized to receive heparin alone. An additional 6 patients were excluded because they did not actually receive a thrombolytic agent despite their randomization assignment to thrombolysis. Four patients who lacked data about
Patient Profile
Of the 308 patients, the mean duration of PE symptoms before thrombolysis was 3.7 ± 0.2 days. The mean age of patients was 58 years (range 18 to 86). Initial lung scans in 262 patients showed a mean perfusion defect of 41 ± 1%. Twenty-four hours after the initiation of thrombolysis, the lung scans showed a mean perfusion defect of 29 ± 1%, representing an absolute mean improvement in perfusion of 12 ± 1%. Initial quantitative angiographic scores in 222 patients showed a mean angiographic score
Discussion
With each additional day of PE symptoms, there was a small decrement in the efficacy of thrombolysis, as assessed by lung scan reperfusion and angiographic improvement. Nevertheless, substantial benefit extended to 14 days after symptom onset.
The Urokinase Pulmonary Embolism Trial[10]of 82 thrombolysis patients examined the effects of PE symptom duration on the efficacy of thrombolysis. Results indicated that urokinase treatment, assessed by lung scanning, was more effective in those with
Acknowledgements
Dr. Goldhaber received support from the Academic Award in Systemic and Vascular Medicine Grant HL 02663 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
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2022, International Journal of CardiologyCitation Excerpt :Although, there is a clear consensus in the emergency use of thrombolytic therapy, there is not a clearly defined ideal time of thrombolysis. Despite the short therapeutic window in acute myocardial infarction and ischemic stroke, thrombolysis might be administered during the 14 days after the beginning of symptoms in PE according to available literatures [1,4–6]. According to more recent studies, despite this longer therapeutic window, the patients who received early thrombolytic therapy in first 5 days had better outcomes [1,2,7,8].
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