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EFFECTIVENESS OF THROMBOLYTIC THERAPY IN PULMONARY THROMBOEMBOLISM

EFFECTIVENESS OF THROMBOLYTIC THERAPY IN PULMONARY THROMBOEMBOLISM. Gülfer Okumuş*, Rabia Ünver*, Esen Kıyan*, Halim İşsever**, Orhan Arseven* Istanbul University, Istanbul Medical Faculty, *Department of Pulmonary Disease, **Department of Public Health. Introductio n.

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EFFECTIVENESS OF THROMBOLYTIC THERAPY IN PULMONARY THROMBOEMBOLISM

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  1. EFFECTIVENESS OF THROMBOLYTIC THERAPY IN PULMONARY THROMBOEMBOLISM Gülfer Okumuş*, Rabia Ünver*, Esen Kıyan*, Halim İşsever**, Orhan Arseven* Istanbul University, Istanbul Medical Faculty, *Department of Pulmonary Disease, **Department of Public Health

  2. Introduction • Thrombolytic agents activate plasminogen to form plasmin, resulting in the accelerated lysis of thrombi. • The studies suggest that thrombolytic therapy accelerates clot lysis and is associated with short-term physiologic benefits. • It is a life saving treatment in massive PTE.

  3. Indications for thrombolytic therapy • Presence of hypotension related to PE • Presence of severe hypoxemia • Substantial perfusion defect • Right ventricular dysfunction associated with PE • Extensive deep vein thrombosis

  4. Contraindications for thrombolytic therapy Absolute • History of hemorrhagic stroke • Active intracranial neoplasm • Recent (< 2 months) intracranial surgery or trauma • Active or recent internal bleeding in prior 6 months

  5. Contraindications for thrombolytic therapy Relative • Bleeding diathesis • Uncontrolled severe hypertension (systolic BP >200 mmHg or diastolic BP >110 mmHg) • Nonhemorrhagic stroke within prior 2 months • Surgery within the previous 10 days • Thrombocytopenia (<100,000 platelets per mm3)

  6. Adverse effects • Bleeding (most common) • Thrombolytic agent-specific adverse reactions • Streptocynase is associated with: • Allergic reactions • Hypotension

  7. Aim • To investigate the effectiveness of thrombolytic therapy in patients with PTE.

  8. Material and Methods • January 2001- December 2006 • 37 patients with PTE • Patients’ demographic, clinic and laboratory characteristics was recorded • The echocardiographic findings were added. • ECHO; before treatment within 24 hours • After treatment within 48 hours

  9. Statistical analysis • T-test • NPar test • Wilcoxon test

  10. Results • 17 females, 20 males • Age= 52.5±17.1 years (16-74years). • 30 patients  CT (+) • 21 patients  Proximal DVT (+) • Systolic BP= 9018mmHg (80-120mmHg) • Diastolic BP= 6011mmHg (50-80mmHg)

  11. Results • Streptocynase  27 patients • Tissue plasminogen activator ( rTPA)  10 patients • Streptocynase (in patients with DVT) • In six patients 48 hours, • In four patients 72 hours

  12. Results • PAP=61.1±22.2mmHg (40-110 mmHg) (before) • PAP=41.6±23.8mmHg (20-100mmHg)(after) x2=5.44; p<0.0001

  13. Results • 31 patients  No complications • Three patients  Minor complications

  14. Results • Three patients  Major complications • Hemothorax (Streptocynase in the 24th hour)(3.1%) • Hypotension (Streptocynase in the 24th hour) • Hypertension (rTPA in the first hour). No patients died due to the thrombolytic therapy

  15. Conclusion In our study, • Thrombolytic therapy significantly decreased the pulmonary arterial pressure. • Complication rate due to the treatment was low.

  16. THANK YOU...

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