Thrombolysis not favored therapy for patients with massive pulmonary embolism

Last Updated: 2001-07-27 17:06:37 EDT (Reuters Health)
מתוך מדיקונטקסט
WESTPORT, CT (Reuters Health) – Patients with massive pulmonary embolism (PE) with right ventricular dysfunction do not appear to receive any additional benefit from thrombolysis treatment compared with heparin therapy, French researchers report.

Dr. Gerard Pacouret and colleagues, from Trousseau University Hospital, Tours, retrospectively evaluated 128 consecutive patients with massive PE who had similar baseline right and left ventricular diameter ratios. Half were treated with thrombolysis and the other half were treated with heparin, according to the report in the July issue of Chest.

Perfusion lung scans were conducted on day 7 and day 10 of treatment. The scans revealed that patients receiving thrombolysis had significantly higher mean relative lung perfusion, 54%, compared with patients receiving heparin treatment, 42% (p = 0.01), the researchers report.

All the patients receiving heparin survived, however four of the patients receiving thrombolysis died. Among these patients one died from shock after thrombolysis, one died from a recurrence of PE and two died from cerebral bleeding.

Furthermore, the difference in severe bleeding between the groups was significant, with no bleeding reported in patients receiving heparin compared with 10 bleeding incidents reported in the thrombolysis group (p = 0.001).

Dr. Pacouret's team notes that the only advantage of thrombolysis over heparin was a 1-week perfusion lung scan improvement, which they point out has been demonstrated in another trial.

"The results of this case-controlled study, do not favor thrombolysis in patients suffering from massive PE with stable hemodynamics and right ventricular dysfunction," they conclude.

In a journal editorial, Dr. Bruce L. Davidson from Seattle, Washington and Dr. Anthonie W. A. Lensing from Amsterdam, question whether right ventricular strain should be the criterion for deciding which PE patients receive thrombolysis. This difference in criterion, they suggest, may explain why the results obtained by Dr. Pacouret's group differ from those reported by other researchers.

Data from the current study indicate "there will be unnecessary deaths and intracranial bleeds," but results from two other studies indicate that "many patients will benefit" from thrombolysis. "We simply don't know what the truth is," Drs. Davidson and Lensing add.

Chest 2001;120:6-8,120-125.

-Westport Newsroom 203 319 2700

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