O.A. Koval, О.М. Kligunenko, O.Yu. Muryzina, О.М. Pavlenko. Effectiveness and safety of the systemic thrombolysis in patients with acute pulmonary embolism and risk of early death

The aim – to evaluate the effectiveness and safety of systemic thrombolysis (TL) in acute PE depending on hospital mortality risk.

Material and methods. 32 patients, among them 21 men (66 %) and 11 women, 54.6±14.6 yrs old, admitted to the intensive care unit with the first episode of acute PE and receiving TL were involved into prospective nonrandomized investigation. According to the ESC Guidelines on PE (2014) patients were stratified as unstable, having shock or hypotension (19; 59.4 %) and patients with intermediary-high mortality risk with stable hemodynamic indexes but massive bilateral emboli according to multispiral computer tomography data (angio regimen), verified signs of the right ventricular overload and positive troponin tests.

Results. General PESI index of the group was 152±18 (119–178) points, which constituted class V of the 30-days mortality risk. Time from symptoms onset to TL fluctuated from 5.2±2.0 hrs in the subgroup with shock, 12.0 hrs in hypotension subgroup and 4.2±0.8 days in the intermediary-high risk subgroup. The first clinical sign of the status amelioration in the shock group was SpO2 increase from 85±1.5 (82–88) tо 92±2 % in 2.5–3.0 hrs, coinciding with decrease of the inotropes dose, tachypnoe and increased diuresis. Medium time of inotrope and vasopressor support in the shock subgroup was longer than in only hypotension group (4.5±1.5 hrs) with further systolic AP restoration to 105±10 mm Hg. In the intermediary-high risk subgroup Wells index was 7–8 points in original version, and revised Geneva Score – 13±2 points. Disease course in this subgroup was not complicated, nevertheless the clinical status restoration was slower with longer dyspnea preservation. In the next 24 hrs after TL hemodynamic indexes were stable in all subgroups. In 36 hrs all subgroups were completely comparable regarding breath rate per min (P=0.063), SpO2 (P=0.56) and heart rate (Р=0.88).

Conclusions. Severity of the embolic overload at the segmentary and more proximal vessel level is comparable with their PESI index both in high and intermediary-high risk patients with PE according to multidetector CT data. Systemic TL in the intermediary-high risk subgroup even with absence of arterial hypotension is a clinically reasonable procedure favoring more rapid SpO2 renovation and hemodynamic stabilization.

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