February 2015 Tucson pulmonary journal club: fibrinolysis for PE

• Main Authors: Ganesh A, Bime C, Gerald J
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2015-02-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: pulmonary embolism; PE; fibrinolysis; complications; tenecteplase; heparin; bleeding; stroke; right ventricular dysfunction; myocardial injury
• Online Access: http://www.swjpcc.com/pulmonary-journal-club/2015/2/26/february-2015-tucson-pulmonary-journal-club-fibrinolysis-for.html

No abstract available. Article truncated at 150 words. The role of fibrinolytic therapy among patients with intermediate-risk pulmonary embo-lism (PE) is controversial (1). When right ventricular dysfunction and myocardial injury are associated with PE, there is an increased risk of adverse events (2). However, the risk of bleeding with fibrinolytic therapy has previously been thought to outweigh the benefits among patients without overt hemodynamic collapse. The Pulmonary Embolism Thrombolysis (PEITHO) trial was a multi-center, double-blind, placebo-controlled randomized trial designed to investigate the efficacy and safety of single-bolus injection with tenecteplase plus heparin anticoagulation versus heparin anticoagulation alone among normotensive patients with intermediate risk PE (3). The study included 1005 adult patients who were randomized within fifteen days of symptom onset; randomization occurred when both right ventricular dysfunction (echocardiography or spiral computed tomography) and myocardial injury (troponin I or T) were present. All patients were followed for 30 days. The primary outcome was death or hemo-dynamic collapse within 7 ...