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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pulmonary embolism is frequently fatal and its treatment and prevention are of vital importance. Curative therapy depends mainly on the use of heparin or urokinase, embolectomy under extracorporeal circulation being reserved for the most severe cases, and Trendelenburg's operation limited in its application at the present time. Prevention of pulmonary embolism is the principal problem and involves, apart from the use of anticoagulants, insertion of a caval clamp by means of a Adams Deweese clip whenever possible, or by the use of an endoluminal filter. Surgical relief of peripheral venous obstruction, apart from very recent proximal phlebitic lesions, is however currently of limited application.
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PMID:[Pulmonary embolism. Medical and surgical treatment (author's transl)]. 705 Feb 72

The proper place of thrombolytic agents in the management of pulmonary embolism is not yet well defined. A number of survivors of acute massive pulmonary thromboembolism remain in a delicate balance of hemodynamic compensation and where recurrent emboli could frequently be fatal. Successful response to urokinase therapy in such a case is presented and the status of currently available thrombolytic drugs is discussed. We suggest that thrombolytic therapy in massive pulmonary embolism would provide greater hemodynamic reserve, alleviate shock, minimize the chances of recurrent emboli and prevent permanent impairment to the pulmonary vascular bed.
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PMID:Case report. Acute cor pulmonale due to massive pulmonary embolism and successful response to thrombolytic therapy. 706 97

Recent deep vein thrombosis of the iliofemoral segment often leads to pulmonary embolism and to impaired valve function. Although more common, occlusions in the calf veins are less dangerous, and often a self-limiting disorder as almost half of these thrombi lyse spontaneously. Approximately 70% of fresh deep venous thrombi dissolve under intensive and prolonged thrombolytic treatment with streptokinase and long-term follow-up studies indicate that normal valve function is preserved in those patients in whom thrombus clearance was obtained. Thrombosis with streptokinase or urokinase appears to be the current treatment of choice for most cases of massive and severe, life-threatening pulmonary embolism; those patients surviving more than an hour or so after massive infarction comprise a prognostically better group, in whom the chances of surviving embolectomy is today smaller than the probability of survival without surgery but with thrombolytic treatment. Obviously there are problems in the evaluation but also in the thrombolytic treatment with streptokinase and urokinase of deep venous thrombosis and pulmonary embolism. These problems do not concern the principle of thrombolysis, but are largely due to the fact that the drugs so far used also induce a systemic fibrinogenolysis resulting in a bleeding risk. There is already good evidence that tissue activator of plasminogen is highly specific for fibrin and can induce thrombolysis in experimental animals without inducing systemic fibrinogenolysis.
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PMID:[Actual state of thrombolytic treatment of recent vein thrombosis and pulmonary embolism (author's transl)]. 719 77

Thirty-eight patients admitted to hospital for pulmonary embolism of recent onset were divides into four treatment groups. Group I patients (10) received streptokinase in does of 250,000 units over 20 minutes, followed by 100,000 units/hour for a total of 24 hours. Group II patients (8) received urinary urokinase 4,500 CTA units/kg/hour during 12 hours. Group III patients (10) were treated with urinary urokinase (112,500 CTA) units/hour during 24 hours) and heparin (500 units/kg/24 hours). Group IV patients (10) were given tissue urokinase and heparin, both in the same dosage as in group III patients. Pulmonary angiography and cavography were performed in all patients before treatment and within 24 hours of its termination. With regard to pulmonary emboli, improvement was most pronounced with streptokinase, with a gain of 15.7 points on Miller's index of severity, as against 9.6, 10.5 and 5.7 points for Group II, III and IV patients respectively. In peripheral venous thrombosis, streptokinase showed even greater superiority over other treatment, with a gain of 16 points of Marder's index, as against zero, 4.5 and 11.2 points for patients in Groups II, III and IV respectively. On biochemical tests, the decrease in fibrinaemia was more pronounced in Group I patients than in other groups.
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PMID:[Effects of thrombolytic agents on pulmonary and venous clots in severe pulmonary embolism (author's transl)]. 722 Feb 91

Although low-dose heparin therapy is the technique most commonly used for prophylaxis of pulmonary thromboembolism, its usefulness is being questioned. Platelet deaggregation prophylaxis with either aspirin or dipyridamole, or both, apparently is a reasonable alternative, but further studies are needed. For treatment of pulmonary thromboembolism, continuous conventional-dose heparin therapy is the approach of choice. It has the highest therapeutic/toxic ratio and is the most effective technique for prevention of clot propagation. The patient's fibrinolytic network must be intact, however, if clot degradation is to occur. Fibrinolytic therapy with urokinase or streptokinase should be restricted to use in patients with massive pulmonary embolism in whom hemodynamics are unstable. Caval interruption and pulmonary embolectomy have lower benefit/risk ratios than do the medical alternatives and are rarely used for pulmonary thromboembolism.
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PMID:Pulmonary thromboembolism. 2. New trends in prophylaxis and therapy. 737 11

Thrombolytic therapy mimics and enhances physiological fibrinolysis. The following substances are presently available for clinical use: the nonphysiological thrombolytics streptokinase, the APSAC (acylated plasminogen-streptokinase activator complex), the physiological plasminogen activators urokinase and tissue plasminogen activator (t-PA). Whereas the first three systematically activate the fibrinolytic system, t-PA possesses relative fibrin selectivity. The fibrin-selective active pro-urokinase has not yet been officially approved for the treatment of thromboembolic diseases, but it is being clinically tested. Fibrinolytic therapy has an established place in the management of acute myocardial infarction and of massive pulmonary embolism. When an acute deep venous thrombosis is diagnosed with a proximal extension into the popliteal vein, thrombolytic therapy is clearly superior to heparin. The lysis has proven to be an effective form of treatment of peripheral occlusive arterial disease. Local thrombolytic therapy is an option for acute and chronic femoro-popliteal occlusions involving the trifurcation into the calf arteries and for embolic occlusions of the same segment in patients with contraindications to surgical therapy. First study results of thrombolytic therapy of stroke are promising.
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PMID:[Fibrinolytic agents--who benefits when?]. 748 76

Patients with a recent (less than 10 days) proximal deep vein thrombosis of the leg or pelvis are candidates for thrombolysis as the major benefit over heparin seems to be the prevention of the postphlebitic limb, an aim which is still not proven in a satisfactory manner. Nonocclusive thrombi appear to lyse more readily than occlusive thrombi. For this indication the optimal dose regimens for the three thrombolytic drugs (streptokinase, urokinase, alteplase) are not established. Acute massive pulmonary embolism with hypotension or shock should be treated with thrombolytic drugs and, pending the outcome in the first hour, be considered for pulmonary embolectomy. Major acute pulmonary embolism with haemodynamic instability responds well to thrombolysis. Whether thrombolysis is superior to heparin in subacute intermediate pulmonary embolism has not been proven unequivocally in terms of mortality or clinically important endpoints. Systemic administration of thrombolytic drugs for peripheral arterial occlusion has been abandoned for catheter-directed and intraoperative intra-arterial repeated bolus or short-term infusions. The efficacy and safety of intravenous thrombolytic treatment following a major ischaemic stroke is presently being tested in large scale trials; its use must be restricted to experimental protocols.
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PMID:Thrombolytic therapy of non-cardiac disorders. 754 71

The incidence of deep venous thrombosis or pulmonary embolism after lung or heart-lung transplantation has not been well defined. Pulmonary embolism may be of particular concern in the postoperative period owing to an inadequately developed or absent collateral bronchial circulation and potential risk of pulmonary infarction. Fourteen (12.1%) of 116 patients undergoing either lung (n = 87) or heart-lung (n = 29) transplantation developed thromboembolic complications 10 days to 36 months after operation. Deep vein thrombosis developed in nine patients, including three with upper body thrombosis related to indwelling central venous catheters. Seven patients (6%) had pulmonary embolism, and three of them died. Resolution of pulmonary embolism was successfully accomplished by selective pulmonary artery infusion of urokinase in three patients without complications. Our experience indicates that deep vein thrombosis and pulmonary embolism are significant problems after lung transplantation. Mortality is high in those patients in whom pulmonary embolism develops. Therefore, a comprehensive prevention protocol is warranted.
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PMID:Deep venous thrombosis and pulmonary embolism after lung transplantation. 763 73

Thrombolytic therapy leads to more rapid dissolution of thrombi in severe pulmonary embolism than conventional heparin therapy but is considered with much reserve in elderly patients because of the risk of haemorrhage, which is thought to be potentially greater in these subjects. The object of this study was to assess the efficacy and safety of thrombolytic therapy in patients over 70 years of age with severe pulmonary embolism, compared with patients under 70 years of age with the same condition. Eighty-nine patients with severe pulmonary embolism (Miller score > 17/34) were prescribed thrombolytic therapy in the absence of a contraindication without taking age into consideration. Fifty-three were under 70 years of age (54 +/- 15; range: 18 to 70 years) and 36 were over 70 years of age (78 +/- 5; range: 71 to 88 years). Apart from age, there was no difference in the clinical presentation of the two groups. Thrombolytic therapy was initiated with streptokinase 100,000 IU/hr for twelve hours after an initial bolus of 250,000 IU or with urokinase or plasminogen tissue activator in cases with a contraindication to streptokinase. An uncomplicated course was observed in the same percentage of cases in the two groups. The Miller score and mean pulmonary pressures fell in the same way in the two groups. Three patients died during the hospital period, two aged under 70 (3.7%) and one over 7 years of age (2.7%). Major bleeding occurred in 3 subjects under 70 (5.6%) and 5 subjects over 70 (13.8%) (p = 0.29).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Efficacy and safety of thrombolytic therapy in the elderly with severe pulmonary embolism]. 764 95

We report a case of renal vein thrombosis (RVT) and pulmonary embolism associated with diffuse membranous glomerulonephritis. A 44-year-old Japanese male was referred to the Nephrology Department with heavy proteinuria. Renal biopsy revealed diffuse membranous glomerulonephritis and we administered PSL 30mg/day and dipyridamole 300mg/day. Three weeks later, he was admitted with severe chest pain, dyspnea and massive proteinuria. RVT and pulmonary embolism were detected on CT scan and perfusion lung scan. After a few days of continuous intravenous unfractionated heparin (UFH) therapy, we used 72 U (anti-FXa)/kg of intravenous low-molecular-weight heparin (LMWH) every 12 hours for 10 days. He also received urokinase at the dose of 120,000 U/day for 4 weeks and long-term therapy with warfarin potassium at the dose of 3 mg/day. One month later, the thrombi in the pulmonary arteries and inferior vena cava disappeared on CT scan and perfusion lung scan. LMWHs have a longer biological half-life and a lower bleeding tendency than UFH for an equivalent antithrombotic effect. This case indicates that intermittent intravenous LMWH administration combined with urokinase is effective against RVT and pulmonary embolism without any side effect.
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PMID:[A case of renal vein thrombosis and pulmonary embolism associated with diffuse membranous glomerulonephritis: the usefulness of low-molecular-weight heparin and urokinase therapy]. 769 54


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