Safety and efficacy of the thrombolytic therapy in submissive pulmonary thromboembolism / 中华急诊医学杂志

ABSTRACT

Objective To study prospectively the safety and efficacy of the thromblytic therapy in acute submassive pulmonary thromboembolism (PTE) without randomized control.Methods A total of consecutive 177 patients with acute submassive PTE admitted to the emergency intensive care unit were screened from June of 2005 to May of 2012.After a comprehensive screening,102 patients were treated with thrombolytic therapy (TT group),and 75 with anticoagulation therapy (AT group).Clinical signs and physical examination findings were recorded 2 hours,24 hours and 7 days after treatment.Echocardiography (ECG) was repeated 24 hours later.Lung perfusion scan and CT pulmonary artery (CTPA) were repeated on the 7th day.All data was analyzed by paired t test and Chi-square test.Results ①Bleeding happened in 6 patients of TT group and in 1 patient of AT group (P ＞ 0.05),and no lethal hemorrhage occurred in the two groups.There were no statistically significant differences in demographics and clinical history of patients between TT group and AT group (P ＞ 0.05).②There were statistically significant changes in respiratory rate,heart rate and systolic blood pressure in the TT group 2 hours after treatment and great changes in systolic pressure of pulmonary artery (SPAP) and tricuspid regurgitation at 24 hours after treatment (P ＜0.01),whereas obvious change in respiratory rate in AT group was found 24 hours after treatment.③In the TT group 7 days after treatment,significant efficiency rate and total improvement of the deep vein thrombosis (DVT) identified by ultrasonography were 83.0％ and 96.2％ respectively,and those of CTPA and lung perfusion scan were 66.7％ and 98％ respectively.The efficiency of TT was significantly superior over AT in this respect (P ＜ 0.01).④The efficiency of TT given within 3 days after onset of PTE was significantly higher than that of TT conferred over 3 days after onset of PTE (P ＜ 0.01).Conclusions ①Thrombolytic therapy is safe and effective for the submassive PTE,but atypical cerebrovascular accident must be rule out first.②Thrombolytic therapy can improve the symptom of the patient in 2 hours compare with AT.③ Thrombus burden can be reduced more obviously in TT group after 7 days treatment compare with the AT group.④The effect of thrombolytic therapy depends on the time as ti given during the course of disease,the earlier administration the better efficacy.