Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A forty-four-year-old man with a clinical diagnosis of diabetes melitus and severe obesity (height 170 cm, weight 108 kg) was admitted to the hospital on 12th January 1995 because of acute myocardial infarction, and on 21st January, he was referred to our hospital with sudden onset of shock, bradycardia, loss of consciousness in spite of having recovered well from myocardial infarction. The echocardiography and pulmonary arteriography revealed a pulmonary embolism and a tumor in the right atrium. Administration of tissue plasminogen activator (TPA) was not sufficiently effective. An emergency operation (pulmonary arteriotomy, right atriotomy, milking of bilateral lungs) with cardiopulmonary bypass revealed a massive consecutive thrombus, which occupied the right atrium, right ventricle and bilateral pulmonary artery. The postoperative course was uneventful.
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PMID:[A case report of right-sided cardiac and pulmonary thromboembolism treated by emergent operation]. 896 99

Although heparin is the primary drug used to treat pulmonary embolism, its limits include poor prevention of recurrence, and slow and delayed normalization of hemodynamic parameters. Over the past decades, thrombolysis has proved to be the most rapid and effective therapy to normalize hemodynamic parameters and angiographic and scintigraphic indexes of obstruction. Studies conducted up to the present have not, however, demonstrated a significant advantage over heparin with respect to mortality. Moreover, thrombolytic drugs carry a greater risk of hemorrhage than heparin. Various experimental studies have demonstrated that the short-term administration of recombinant tissue plasminogen activator (rt-PA) is more effective and decreases risk of hemorrhage. To our knowledge, only a few uncontrolled clinical studies on bolus thrombolysis with urokinase have been done. Studies comparing a 0.6 mg/Kg bolus of intravenous rt-PA versus the infusion of 100 mg over 2 hours have given conflicting results. Of these, some have demonstrated that bolus administration is safer and more effective while others have provided nearly overlapping results regarding safety and the reduction of pulmonary resistances. One study reports higher mortality in a group receiving 0.6 mg/Kg bolus rt-PA. Until these questions are clarified, administration of thrombolytics in the following doses is advised: streptokinase bolus 250,000 U over 30 min + 100,000 U/hour for 24 hours; urokinase bolus 4400 U/Kg for 10 min + 4400 U/Kg/hour for 12-24 hours; rt-PA 100 mg for 2 hours.
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PMID:[Bolus thrombolysis in pulmonary embolism. Review of experimental and clinical data]. 897 39

A 27-year-old woman, after 31 weeks of amenorrhoea during her second pregnancy, developed a left external iliac and femoral deep vein thrombosis, confirmed by venous ultrasonography and magnetic resonance imaging. The infusion of tissue plasminogen activator (rt-PA: 1.2 mg/kg, i.e. 80 mg over 3 hours), on the 2nd day, allowed revascularization of the femoral junction, while the external iliac vein remained occluded. The patient did not develop pulmonary embolism or haemorrhage, particularly obstetric haemorrhage. The subsequent pregnancy was uneventful until delivery, six weeks later, of a normal child. Three years later, the patient has no sequelae of her deep vein thrombosis. When required by the patient's condition, it seems that rt-PA can be used to treat severe deep vein thrombosis during pregnancy, either isolated or complicated by pulmonary embolism. Very rigorous cardiological, obstetric and laboratory surveillance is essential. A sufficient dosage, identical to that used in clinical settings other than pregnancy and a brief treatment duration (2 to 3 hours) are probably more effective and more reliable than lower doses continued for several days. However, the risk of haemorrhage remains difficult to predict and its prognosis, especially foetal, is often very poor. A larger series of cases is therefore necessary before this drug can unreservedly recommended in pregnant women.
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PMID:[Ilio-femoral vein thrombosis treated with tissue plasminogen activator in a pregnant woman]. 903 5

A 22-year-old man was admitted to our hospital because of sudden dyspnea and dizziness. Hypoxemia was found. Lung perfusion scintigraphy and pulmonary angiography showed massive pulmonary thromboembolism. The patient received E6010, a derivative of tissue plasminogen activator by intravenous injection for about 2 minutes. One hour after this treatment, pulmonary angiography showed lysis of the ciot, the pulmonary arterial pressure had decreased, and the cardiac index and PaO2 had increased. Despite anticoagulant therapy, pulmonary embolism recurred so we implanted a Greenfield filter in the inferior vena cava. This was the first case of pulmonary thromboembolism in which E6010 had a beneficial effect. We were also able to document hemodynamic and radiologic changes after intravenous infusion of this drug. Recurrent pulmonary embolism is an indication for filter placement, and this patient will need a long period of follow-up.
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PMID:[Acute pulmonary thromboembolism treated with E6010]. 921 64

The efficacy and safety of thrombolysis in patients with cancer with pulmonary embolism is uncertain. Therefore we studied the effects of thrombolysis in 57 patients with cancer and 254 patients without cancer who were treated in five clinical trials with tissue plasminogen activator or urokinase for pulmonary embolism. Immediately after thrombolysis, the proportion of patients with and without cancer who improved on follow-up angiography (77% vs 73%; p = 0.65) was similar. The angiogrophic reduction in clot burden (1.83 +/- 0.27 vs 1.38 +/- 0.13; p = 0.13) was somewhat greater in patients with cancer than in patients without cancer. Twenty-four hours after initiation of thrombolytic therapy, the proportion of patients who improved on follow-up perfusion scan continued to be similar (72% vs 78%; p = 0.40). However, the extent of reperfusion at 24 hours was less in patients with cancer than in patients without cancer (6% vs 13% reperfusion of lung tissue; p = 0.007). These data suggest that patients with cancer should receive effective anticoagulation in the upper portion of the therapeutic range immediately after thrombolysis. It is possible that such a strategy might preserve initial improvement from thrombolysis and prevent attenuation of benefit during the ensuing 24 hours.
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PMID:Attenuation over 24 hours of the efficacy of thrombolysis of pulmonary embolism among patients with cancer. 935 25

Pulmonary embolism can be a catastrophic event leading to early death or serious hemodynamic instability. Thrombolytic therapy, in addition to heparin therapy, may improve the clinical condition and reduce the chance of recurrent pulmonary embolism in some cases. However, the acceptable "time window" for thrombolytic therapy is not well documented, though it has been used successfully as late as 14 days after pulmonary embolism. Successful delayed thrombolytic therapy beyond this "time window" in patients with massive pulmonary embolism has not been reported. We report a case of massive pulmonary embolism in which thrombolytic therapy was delayed more than 1 month after symptom onset. A 56-year-old woman was taken to National Cheng Kung University Hospital because of an episode of recurrent syncope, followed by progressive shortness of breath of 1 month's duration. Hypoxemia and hemodynamic instability were noted on admission. Echocardiography and a lung perfusion scan provided strong evidence of pulmonary embolism. Subsequent pulmonary angiography confirmed the diagnosis of multiple pulmonary emboli. The patient received a standard dose of intravenous tissue plasminogen activator 7 days after admission because of persistent symptoms and hypoxemia. Her clinical condition dramatically improved after treatment. Follow-up imaging studies showed resolution of the emboli. She was discharged in good condition. This case suggests that delayed thrombolytic therapy in patients with massive pulmonary embolism can still be beneficial in selected cases, even if given more than 2 weeks after symptom onset.
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PMID:Successful delayed thrombolytic therapy in a patient with massive pulmonary embolism. 979 33

Renal vein thrombosis can occur as a complication of nephrotic syndrome. We present the case of a young man with nephrotic syndrome caused by minimal change disease who developed acute inferior vena cava and left renal vein thrombosis. He was treated initially with intravenous heparin. Because of the persistence of severe left flank pain and gross hematuria, local infusion of recombinant tissue plasminogen activator was tried, with resolution of thrombi and subsidence of symptoms. Functional preservation of the involved kidney is good, as indicated by Tc-99m DMSA scan (involved kidney, 47.4%; uninvolved kidney, 52.6%). Anticoagulation is usually recommended as the treatment of choice in renal vein thrombosis. We believe that in cases with critical presentations, such as bilateral involvement, extension into inferior vena cava, acute renal failure, pulmonary embolism or severe flank pain, thrombolytic therapy should be considered as a second-line treatment if good response is not obtained with heparin.
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PMID:Successful treatment of acute inferior vena cava and unilateral renal vein thrombosis by local infusion of recombinant tissue plasminogen activator. 985 27

Streptokinase, urokinase, tissue plasminogen activator and similar drugs can all cause lysis of venous thrombi and pulmonary emboli, but there is small evidence that accelerated lysis achieves a significantly better clinical outcome, on average, in the shorter or longer term, than heparin alone. Thrombolytic therapy for deep leg vein thrombosis aims to restore flow and to preserve venous valves, and so to prevent chronic post-phlebitic disability, but no trial has convincingly demonstrated that the last can be achieved in more than a few patients. Only a small minority of people with extensive proximal thrombosis develop disabling post-phlebitic venous insufficiency, and there are no good clinical predictors of this outcome. As a result, any widespread use of thrombolytics would bring an immediate risk of major bleeding to many people who will never be destined to develop a clinically important problem. Thrombolytic therapy after venous thrombosis should be avoided except, perhaps, in a few carefully selected patients with severe obstruction. The case for using thrombolytics after recent pulmonary embolism is strongest in the limited number of patients with ongoing hypoxia, respiratory distress, pulmonary hypertension and right heart failure, because thrombolytic therapy often achieves an impressive and almost immediate clinical benefit in this clinical setting. Whether early relief from pulmonary artery obstruction translates into longer-term advantage over heparin remains uncertain, however, because no comparative trial has ever shown these drugs to reduce mortality after pulmonary embolism. In all cases, both the physician and the patient must balance the certainty of an immediate bleeding risk against the uncertainty of a better than marginal real benefit.
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PMID:Thrombolytic therapy for venous thrombosis and pulmonary embolism. 1033 Oct 98

The purpose of this article is to report four patients with massive pulmonary embolism treated with percutaneous catheter and guidewire fragmentation and local administration of recombinant tissue plasminogen activator (r-TPA). Four patients with massive pulmonary embolism initially underwent pulmonary angiography. Thrombus fragmentation was performed with both standard angiographic guidewires and catheters followed by local infusion of 41-200 mg of r-TPA. Pulmonary angiography was repeated after treatment. All patients survived with improvement in their clinical status and eventual discharge from hospital. Angiography in all patients post treatment demonstrated improvement in pulmonary perfusion (mean Miller score before treatment 22.5; mean Miller score after treatment 5.75). No patient had a significant complication. Mechanical fragmentation of the thrombus followed by local infusion of r-TPA was an effective treatment for massive pulmonary embolism in these four patients with no significant complications.
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PMID:Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism. 1037

We report the successful use of thrombolysis for acute massive pulmonary embolism 2 days after right lower lobectomy for bronchial adenocarcinoma. Pulmonary angiography revealed extensive clot unsuitable for surgical embolectomy. A bolus infusion of recombinant tissue plasminogen activator produced an immediate improvement in the patient's hemodynamic state. There was substantial blood loss requiring the transfusion of 21 units of blood over the postoperative period. The patient made a successful recovery and remained well at 1 year.
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PMID:Successful thrombolysis for massive pulmonary embolism after pulmonary resection. 1039 Dec 96


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