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Alteplase improves the clinical course of patients with major pulmonary embolism: A multicenter, randomized, placebo-controlled trial (Management Strategies and Prognosis in Pulmonary Embolism Study 3)
No full textAlteplase improves the clinical course of patients with major pulmonary embolism: A multicenter, randomized, placebo-controlled trial (Management Strategies and Prognosis in Pulmonary Embolism Study 3)
No full textPredictors of mortality after massive pulmonary embolism: Prognostic impact of clinical symptoms and early 12-lead ECG (Management and Prognosis of Pulmonary Embolism Registry-MAPPET)
No full text
Predictors of mortality after massive pulmonary embolism: Prognostic impact of clinical symptoms and early 12-lead ECG (Management and Prognosis of Pulmonary Embolism Registry-MAPPET)
No full textN-terminal pro-BNP testing combined with echocardiography for risk stratification of acute pulmonary embolism
No full textN-terminal pro-BNP testing combined with echocardiography for risk stratification of acute pulmonary embolism
No full textPrognostic value of the ECG on admission in patients with acute major pulmonary embolism
No full textA number of ECG abnormalities can be observed in the acute phase of pulmonary embolism (PE). Their prognostic value has not yet been systematically studied in large patient populations. In 508 patients with acute major PE derived from a large prospective registry, the current authors assessed, on admission, the impact of specific pathological ECG findings on early (30-day) mortality. Atrial arrhythmias, complete right bundle branch block, peripheral low voltage, pseudoinfarction pattern (Q waves) in leads III and aVF, and ST segment changes (elevation or depression) over the left precordial leads, were all significantly more frequent in patients with a fatal outcome. Overall, 29% of the patients who exhibited at least one of these abnormalities on admission did not survive to hospital discharge, as opposed to only 11% of the patients without a pathological 12-lead ECG. Multivariate analysis revealed that the presence of at least one of the above ECG findings was, besides haemodynamic instability, syncope and pre-existing chronic pulmonary disease, a significant independent predictor of outcome. In conclusion, ECG may be a useful, simple, non-costly tool for initial risk stratification of patients with acute major pulmonary embolism
Heparin plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism
No full textBackground: The use of thrombolytic agents in the treatment of hemodynamically stable patients with acute submassive pulmonary embolism remains controversial. Methods: We conducted a study of patients with acute pulmonary embolism and pulmonary hypertension or right ventricular dysfunction but without arterial hypotension or shock. The patients were randomly assigned in double-blind fashion to receive heparin plus 100 mg of alteplase or heparin plus placebo over a period of two hours. The primary end point was in-hospital death or clinical deterioration requiring an escalation of treatment, which was defined as catecholamine infusion, secondary thrombolysis, endotracheal intubation, cardiopulmonary resuscitation, or emergency surgical embolectomy or thrombus fragmentation by catheter. Results: Of 256 patients enrolled, 118 were randomly assigned to receive heparin plus alteplase and 138 to receive heparin plus placebo. The incidence of the primary end point was significantly higher in the heparin-plus-placebo group than in the heparin-plus-alteplase group (P=0.006), and the probability of 30-day event-free survival (according to Kaplan-Meier analysis) was higher in the heparin-plus-alteplase group (P=0.005). This difference was due to the higher incidence of treatment escalation in the heparin-plus-placebo group (24.6 percent vs. 10.2 percent, P=0.004), since mortality was low in both groups (3.4 percent in the heparin-plus-alteplase group and 2.2 percent in the heparin-plus-placebo group, P=0.71). Treatment with heparin plus placebo was associated with almost three times the risk of death or treatment escalation that was associated with heparin plus alteplase (P=0.006). No fatal bleeding or cerebral bleeding occurred in patients receiving heparin plus alteplase. Conclusions: When given in conjunction with heparin, alteplase can improve the clinical course of stable patients who have acute submassive pulmonary embolism and can prevent clinical deterioration requiring the escalation of treatment during the hospital stay
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