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Acta Medica Colombiana
versão impressa ISSN 0120-2448
Resumo
OROZCO-LEVI, Mauricio et al. Therapy with local fibrinolysis directed by catheter in intermediate risk pulmonary thromboembolism. Acta Med Colomb [online]. 2019, vol.44, n.1, pp.17-24. Epub 12-Jun-2019. ISSN 0120-2448.
Introduction:
in patients with acute pulmonary embolism (PE), local arterial fibrinolysis can have a very favorable relationship between benefits and risks.
Objective:
to characterize the epidemiological and clinical conditions of patients with intermediate-risk of acute PE who have received urgent fibrinolytic therapy directed by catheter.
Methods:
a descriptive study of a series of cases of patients treated at the Cardiovascular Foundation of Colombia (2012-2016 period) with a diagnosis of intermediate-risk PE who received fibrinolytic therapy using a pulmonary catheter.
Results:
27 cases were included (26 patients, 57 ± 20 years, 52% women). Confirmation of acute pulmonary embolism was performed by angiotomography. 85% of the cases showed echocardiographic signs of right ventricular dysfunction, 74% elevation of troponins, and 82% elevation of BNP or pro-BNP. The door-needle time from diagnosis to fibrinolysis was 29 ± 31 hours (max-min, 2-120). The endovascular treatment included alteplase (total dose, 47 ± 18 mg) and mechanical fragmentation-aspiration by pulmonary catheter. 78% of the patients showed decreases in PAPm> 10% of the initial value [i.e., responding patients, ΔPAPm = -27 ± 11% (-9 ± 5 mmHg)]. Five patients were classified as non-responders (ΔPAPm = -2 ± 7%, -1 ± 4 mmHg). The stay in the ICU was 7 ± 5 days (1-19), and the hospital stay was 13 days (1-36). There were no complications of major or other bleeding. The 90-day survival was 100%.
Conclusions:
this series shows that pulmonary arterial fibrinolysis induces an immediate hemodynamic improvement in a high proportion of patients with intermediate-risk PE with a favorable benefit-risk balance in the absence of immediate or delayed attributable complications. (Acta Med Colomb 2019; 44: 17-24).
Palavras-chave : pulmonary embolism; fibrinolysis; thrombolytic therapy; thrombectomy.