Wednesday, May 03, 2006

Massive PE

Wednesday May 03, 2006
What if even thrombolysis fails in massive PE ?

For intensivists massive pulmonary Embolism (PE) is a dreaded situation, especially when even thrombolysis fails. Meneveau and coll. from france have studied such group of 40 patients who did not respond to thrombolysis. Results were published recently in chest.

14/40 patients who were treated by rescue surgical embolectomy were compared with 26/40 patients who were treated by repeat thrombolysis.

  • There was a trend for higher mortality in the medical group than in the surgical group (10 vs 1 deaths).
  • Also, there were significantly more recurrent PEs in the repeat thrombolysis (35% vs 0%).
  • While no significant difference was observed in number of major bleed, all bleeding events in the repeat-thrombolysis group were fatal.

Study concluded that rescue surgical embolectomy led to a better in-hospital course when compared with repeat thrombolysis in patients with massive PE who have not responded to thrombolysis.

See comprehensive review,
Pulmonary Embolism just updated 2 days ago at by Craig Feied M.D.

References: Click to get abstract/article
Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism - Chest. 2006;129:1043-1050