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Clinical InvestigationsPulmonary EmbolismThrombolysis or Heparin Therapy in Massive Pulmonary Embolism With Right Ventricular Dilation: Results From a 128-Patient Monocenter Registry
Section snippets
Patients
From January 1992 to December 1997, 153 consecutive patients with massive PE were admitted to the ICU of the cardiology department and were treated either with thrombolysis (n = 80) or heparin (n = 73).
Results
The baseline characteristics of the two groups of patients were similar, as shown in Table 1. The mean age of the patients was 72 ± 12 years. Approximately 15% of them had a previous PE history. Pulmonary arterial systolic pressure was 56 ± 12 mm Hg, and mean RV/LV ratios were 0.80 and 0.81, respectively. Lung scan defect was higher in group 1 (thrombolysis; 46 ± 10%) than in group 2 (heparin; 43 ± 11%) but without significant difference.
Mean relative improvement in perfusion lung scan defect
Discussion
Doppler echocardiography is particularly useful for detection of right ventricular dysfunction in severe or massive PE.12,13 RV/LV end-diastolic diameter ratio, though not commonly used in North America, has been validated in various studies as a very sensitive criterion for the diagnosis of PE severity. Come14 showed a good correlation between the RV/LV end-diastolic diameter ratio measured in parasternal view and the percentage of vascular obstruction. Fournier et al15showed, in a series of
Conclusion
Despite several limitations regarding its retrospective design and the small number of included patients, the results of this case-controlled study do not favor thrombolysis in patients suffering from massive PE with stable hemodynamics and right ventricular dysfunction. To demonstrate which treatment, thrombolysis or heparin, has the best efficacy/safety profile will require a large-scale, prospective randomized trial.
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