Why the study?
Does thrombolytic therapy plus heparin improve hemodynamics and reduce mortality compared to unfractionated heparin alone in patients with sub-massive pulmonary thromboemboli?
Does thrombolytic therapy plus heparin improve hemodynamics and reduce mortality compared to unfractionated heparin alone in patients with sub-massive pulmonary thromboemboli?
In patients with sub-massive pulmonary embolism, thrombolytic therapy improves early hemodynamic parameters compared to heparin alone, but does not significantly affect mortality.
Background: Thrombolytic therapy in patients with sub-massive pulmonaryembolism (SMPTE) needs further assessment. Objectives: The current study aimed to assess a potential benefit of thrombolytic and non-thrombolytic therapy in patients with SMPTE. Patients and Methods: One hundred-nineteen patients were enrolled with SMPTE from 2006 to 2010 in the tertiary care center of Rajaie medical and research center. The patients who had pulmonary thromboemboli (PTE) and received thrombolytic plus heparin therapy and or non-thrombolytic (unfractionated heparin alone) were evaluated for hemodynamic changes (blood pressure, pulse rate, pulmonary artery systolic pressure, right ventricular failure and right ventricle enlargement), before and after 48 hours of treatment. The mortality rate was also assessed. Results: Forty-five percent of the patients with SMPTE received thrombolytic therapy (streptokinase) and 55% of SMPTE patients received non-thrombolytic therapy (unfractionated heparin). Pulse rate, pulmonary arterial pressure and tricuspid regurgitation gradient in patients receiving thrombolytic therapy reduced significantly (P = 0.001, P = 0.01 and P= 0.001, respectively). There was no significant difference before and after treatment regarding systolic blood pressure (P = 0.4), diastolic blood pressure (DBP) (P = 0.5), systolic arterial pressure (SPAP) (P= 0.1), Right ventricular (RV) function (P = 0.1) and RVsize (P = 0.1). In patients who received a non-thrombolytic therapy, there were no significant differences between the groups regarding SBP(P= 0.2), DBP( P= 0. 4) and PR (P=0.1), SPAP (P = 0.6), TRG (P = 0.4), RV function (P= 0.4) and RVsize (P = 0.2) before and after treatment. There were no significant differences between the groups according to mortality rate. Conclusions: Thrombolytic therapy lead to earlier relief of hemodynamic condition in comparison to non-thrombolytic therapy but no changes were observed in mortality rate.
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Shojaeifard et al. (2016) studied this question.
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