Systemic thrombolysis in haemodynamically unstable pulmonary embolism: The earlier the better?
Thromb Res
; 173: 117-123, 2019 01.
Article
en En
| MEDLINE
| ID: mdl-30522023
INTRODUCTION: The temporal window for the administration of systemic thrombolysis (ST) in acute pulmonary embolism (PE) has not yet been clarified. We assessed the relationship between short-term cardiovascular (CV) mortality and time of ST administration. MATERIAL AND METHODS: Among 394 consecutive patients admitted between January 2010 and June 2017 with a confirmed PE, we retrospectively review the clinical and instrumental data of those labelled as high-risk PE (nâ¯=â¯76, 41 males, mean aged 64.7⯱â¯9.1â¯years old). RESULTS: A receiving operating curve (ROC) analysis established the optimal temporal threshold for the administration of the ST, in respect to the 30-day CV mortality at 8.5â¯h from the symptom onset (Area under Curve 0.79⯱â¯0.6, 95% CI 0.73-0.86, pâ¯<â¯0.0001). Mantel-Cox analysis showed that there was a significant difference in the distribution of survival between patients treated within 8.5â¯h from the beginning of symptoms onset to those treated after 8.6â¯h [log rank (Mantel-Cox) chi-square 9.68 pâ¯=â¯0.002]. Cox-regression analysis demonstrated that the administration of ST after 8.6â¯h from the symptom's onset was an independent predictor of 30-day CV mortality in high-risk PE patients (HR 7.81, 95% CI 1.84-33.05, pâ¯=â¯0.005), independently from the occurrence of major bleeding events (HR 5.89, 95% CI 1.38-25.13, pâ¯=â¯0.01), previous CAD (HR 3.31, 95& CI 1.07-10.231. pâ¯=â¯0.03), RV/LV ratio after 2â¯h from the administration STâ¯>â¯1 (HR (12.91, 95% CI 3.04-54.77, pâ¯=â¯0.001) and PAH at discharge (HR 3.86, 95% CI 2.22-4.68, pâ¯=â¯0.002). CONCLUSIONS: ST administered within 8.5â¯h from symptoms onset may be associated with a reduced 30-day CV mortality in high-risk PE patients.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_cardiovascular_diseases
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6_other_respiratory_diseases
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6_venous_thromboembolic_disease
Asunto principal:
Embolia Pulmonar
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Inhibidores de Agregación Plaquetaria
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Terapia Trombolítica
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Anticoagulantes
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Thromb Res
Año:
2019
Tipo del documento:
Article
País de afiliación:
Italia