PMID- 36329861
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221215
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 6
IP  - 10
DP  - 2022 Oct
TI  - Low dose peripheral systemic thrombolysis for treatment of intermediate-high risk 
      acute pulmonary embolism: a case series.
PG  - ytac417
LID - 10.1093/ehjcr/ytac417 [doi]
LID - ytac417
AB  - BACKGROUND: The management of intermediate-high-risk acute pulmonary embolism 
      (PE) is controversial with increasing interest in more aggressive treatment 
      approaches than anticoagulation alone. CASE SUMMARY: We describe the case series 
      of four consecutive patients who presented to emergency room for acute shortness 
      of breath. They were diagnosed with intermediate-high-risk acute PE based on the 
      computed tomography pulmonary angiography and transthoracic echocardiography 
      (TTE) findings and the elevated simplified PE score index. They received bolus of 
      5 mg thrombolytics recombinant tissue plasminogen activator (rtPA) administered 
      through peripheral intravenous (i.v.) line followed by continuous infusion at a 
      rate of 2 mg/h along with unfractionated heparin (UFH) at a rate of 500 mg/h for 
      additional </=10 h. There after the dose of UFH was increased to reach a 
      therapeutic level. Rapid clinical improvement and also improvement in TTE 
      parameters were noted at discharge. Patients were discharged home on oral 
      anticoagulation. DISCUSSION: Intermediate-high-risk acute PE carries increased 
      risk of mortality and morbidities. Catheter-directed thrombolysis uses a low rtPA 
      dose for local thrombolysis and is associated with low bleeding risk; however it 
      is expensive and requires expertise and human resources. Low-dose rtPA through a 
      peripheral i.v. line might be safe and effective in the treatment of patient with 
      intermediate-high-risk acute PE. This therapeutic approach is readily available 
      at most medical centres, can be started in the emergency room (ER), and can be 
      alternative to catheter-directed thrombolysis nowadays during the COVID-19 era 
      and in hospitals at the periphery and with limited resources.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Charif, Fida
AU  - Charif F
AUID- ORCID: 0000-0002-5869-1778
AD  - Pulmonology Division, Beirut Cardiac Institute, Airport road, 1002, Beirut, 
      Lebanon.
FAU - Khatoun, Houda
AU  - Khatoun H
AUID- ORCID: 0000-0002-3585-6138
AD  - Radiology Division, Beirut Cardiac Institute, Airport road, 1002, Beirut, 
      Lebanon.
FAU - Nassar, Pierre
AU  - Nassar P
AD  - Cardiology Division, Beirut Cardiac Institute, Airport road, 1002, Beirut, 
      Lebanon.
FAU - Jouni, Aya
AU  - Jouni A
AD  - Faculty of Medical Sciences, Lebanese University, Hadath-Baabda, Beirut, Lebanon.
FAU - Jaber, Sadek
AU  - Jaber S
AD  - Faculty of Medical Sciences, Lebanese University, Hadath-Baabda, Beirut, Lebanon.
FAU - Moussa, Malek
AU  - Moussa M
AD  - Cardiology Division, Beirut Cardiac Institute, Airport road, 1002, Beirut, 
      Lebanon.
FAU - Choumar, Bilal
AU  - Choumar B
AD  - Radiology Division, Beirut Cardiac Institute, Airport road, 1002, Beirut, 
      Lebanon.
FAU - Karrowni, Wassef
AU  - Karrowni W
AD  - Department of Cardiovascular Diseases, UnityPoint Health-St. Luke's Hospital, 
      Cedar Rapids, IA 52402, USA.
LA  - eng
PT  - Case Reports
DEP - 20221012
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
EIN - Eur Heart J Case Rep. 2022 Dec 12;6(12):ytac467. PMID: 36518329
PMC - PMC9617477
OTO - NOTNLM
OT  - Case report
OT  - Intermediate-high-risk pulmonary embolism
OT  - RV/LV ratio
OT  - Thrombolysis
EDAT- 2022/11/05 06:00
MHDA- 2022/11/05 06:01
PMCR- 2022/10/12
CRDT- 2022/11/04 02:19
PHST- 2022/04/19 00:00 [received]
PHST- 2022/06/24 00:00 [revised]
PHST- 2022/10/10 00:00 [accepted]
PHST- 2022/11/04 02:19 [entrez]
PHST- 2022/11/05 06:00 [pubmed]
PHST- 2022/11/05 06:01 [medline]
PHST- 2022/10/12 00:00 [pmc-release]
AID - ytac417 [pii]
AID - 10.1093/ehjcr/ytac417 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2022 Oct 12;6(10):ytac417. doi: 10.1093/ehjcr/ytac417. 
      eCollection 2022 Oct.