Skip to main content
SpringerLink
Log in

Thrombolysis in Special Situations

  • Chapter
Thrombolysis in Pulmonary Embolism

  • 1042 Accesses

Abstract

Physicians treating acute pulmonary embolism take decisions based on current guidelines and recommendations; however in specific conditions as in-transit thrombus and pregnant women, specific guidance from recent guidelines may be absent; furthermore if activated factors oral anticoagulants could be used as adjunctive treatment in PE patients submitted to thrombolysis is an open question. In this chapter a review of the evidence in these specific clinical conditions was performed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kronik G. The European Cooperative Study on the clinical significance of right heart thrombi, European Working Group on Echocardiography. Eur Heart J. 1989;10:1046–59.

    Google Scholar 

  2. Begieneman MVP, Van de Goot FRW, Van der Bilt IAC, Vonk Noordegraaf C, Spreeuwenberg MD, Paulus WJ, Van Hinsbergh VWM, Visser FC, Niessen HWM. Pulmonary embolism causes endomyocarditis in the human heart. Heart. 2008;94:450–6.

    Article  CAS  PubMed  Google Scholar 

  3. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med. 2002;136:691–700.

    Article  PubMed  Google Scholar 

  4. Ogren M, Bergqvist D, Eriksson H, Lindblad B, Sternby NH. Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23796 consecutive autopsies. Eur Heart J. 2005;26:1108–14.

    Article  PubMed  Google Scholar 

  5. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–9.

    Article  CAS  PubMed  Google Scholar 

  6. Torbicki A, Galié N, Covezzoli A, Rossi E, De la Rosa M, Golldhaber SZ. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Registry (ICOPER). J Am Coll Cardiol. 2003;41:2245–51.

    Article  PubMed  Google Scholar 

  7. Chapoutot L, Nazeyrollas P, Metz D, Maes D, Maillier B, Jennesseaux C, Elaerts J. Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management. Cardiology. 1996;87:169–74.

    Article  CAS  PubMed  Google Scholar 

  8. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23:1225–30.

    Article  PubMed  Google Scholar 

  9. Pierre-Justin P, Pierard L. Management of mobile right heart thrombi: a prospective series. Int J Cardiol. 2005;99:381–8.

    Article  PubMed  Google Scholar 

  10. Chartier L, Bera J, Delomez M, Asseman P, Beregi JP, Bauchart JJ, Warembourg H, Théry C. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation. 1999;99:2779–83.

    Article  CAS  PubMed  Google Scholar 

  11. Mohan B, Chhhabra S, Gulati A, Mittal C, Mohan G, Tandon R, Kumbkarni S, Aslam N, Soodnk NK, Wander GS. Clinical and echocardiographic diagnosis, follow-up and management of right sided cardiac thrombi. Indian Heart J. 2013;65:529–35.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Mollazadeh R, Ostovan MA, Abdi Ardekani AR. Right cardiac thrombus in transit among patients with pulmonary thromboemboli. Clin Cardiol. 2009;32:E27–31.

    Article  PubMed  Google Scholar 

  13. Casazza F, Bongarzoni A, Centonze F, Morpurgo M. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. Am J Cardiol. 1997;79:1433–5.

    Article  CAS  PubMed  Google Scholar 

  14. Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest. 2002;121:806–14.

    Article  PubMed  Google Scholar 

  15. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, Gibbs JSR, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Noordegraaf AV, Zamorano JL, Zompatori M. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:3033–80. doi:10.1093/eurheartj/ehu283.

    Article  PubMed  Google Scholar 

  16. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg NA, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK, On behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Peripheral Vascular Disease, and Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788–830. doi:10.1161/CIR.0b013e318214914f.

    Article  PubMed  Google Scholar 

  17. Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser K, Rauber K, Iversen S, Redecker M, Kienast J, Just H, Kasper W. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation. 1997;96:882–8.

    Article  CAS  PubMed  Google Scholar 

  18. Arcasoy SM, Kreit JW. Thrombolytic therapy of pulmonary embolism. Chest. 1999;115:1695–707.

    Article  CAS  PubMed  Google Scholar 

  19. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, Kumbhani DJ, Mukherjee D, Jaff MR, Giri J. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage a meta-analysis. JAMA. 2014;311:2414–21.

    Article  PubMed  Google Scholar 

  20. Ferrari E, Benhamou M, Berthier F, Baudouy M. Mobile thrombi of the right heart in pulmonary embolism: delayed disappearance after thrombolytic therapy. Chest. 2005;121:1051–3.

    Article  Google Scholar 

  21. Greco F, Bisignani G, Serafini O, Guzzo D, Stingone A, Plastina F. Successful treatment of right heart thromboemboli with IV recombinant tissue-type plasminogen activator during continuous echocardiographic monitoring: a case series report. Chest. 1999;116:78–82.

    Article  CAS  PubMed  Google Scholar 

  22. Myers PO, Bounameaux H, Panos A, Lerch R, Kalangos A. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest. 2010;137:164–70.

    Article  PubMed  Google Scholar 

  23. Thomppson T, Evans W. Paradoxical embolism. QJM. 1930;23:135–50.

    Article  Google Scholar 

  24. Meacham III RR, Headley AS, Bronze MS, Lewis JB, Rester MM. Impending paradoxical embolism. Arch Intern Med. 1998;158:438–48.

    Article  PubMed  Google Scholar 

  25. Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation. 2003;107:5–9.

    Article  PubMed  Google Scholar 

  26. Doyen D, Castellani M, Moceri P, Chiche O, Lazdunski R, Bertora D, Cerboni P, Chaussade C, Ferrari E. Patent foramen ovale and stroke in intermediate-risk pulmonary embolism. Chest. 2014;146:967–73.

    Article  PubMed  Google Scholar 

  27. Leacche M, Unic D, Goldhaber SZ, Rawn JD, Aranki SF, Couper GS, Mihaljevic T, Rizzo RJ, Cohn LH, Aklog L, Byrne JG. Modern surgical treatment of massive pulmonary embolism: results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg. 2005;129:1018–23.

    Article  PubMed  Google Scholar 

  28. Major WK, Embolism P. Review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest. 2002;121:877–905.

    Article  Google Scholar 

  29. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263:2753–9.

    Article  Google Scholar 

  30. Kuo WT, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV. Catheter directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques. J Vasc Interv Radiol. 2009;20:1431–40.

    Article  PubMed  Google Scholar 

  31. The ATLANTIS. ECASS, and NINDS rt-PA Study Group Investigators Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363:768–74.

    Article  Google Scholar 

  32. Conti E, Zezza L, Ralli E, Comito C, Sada L, Passerini J, Caserta D, Rubattu S, Autore C, Moscarini M, Volpe M. Pulmonary embolism pregnancy. J Thromb Thrombolysis. 2013. doi:10.1007/s11239-013-0941-9.

    Google Scholar 

  33. Eichinger S, Weltermann A, Philipp K. Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden. Thromb Haemost. 1999;82:1232–6.

    CAS  PubMed  Google Scholar 

  34. Heit JA, Kobbervig CE, James AH. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143:697–706.

    Article  PubMed  Google Scholar 

  35. Te Raa DG, Ribbert LSM, Snijder RJ, Biesma DH. Treatment options in massive pulmonary embolism during pregnancy. A case-report and review of literature. Thromb Res. 2009;124:1–5.

    Article  Google Scholar 

  36. Turrentine MA, Braems G, Ramirez MM. Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet Gynecol Surv. 1995;50:534–41.

    Article  CAS  PubMed  Google Scholar 

  37. Leonhardt G, Gaul C, Nietsch HH. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis. 2006;21:271–6.

    Article  PubMed  Google Scholar 

  38. Holden EL, Ranu H, Sheth A. Thrombolysis for massive pulmonary embolism in pregnancy—a report of three cases and follow up over a two year period. Thromb Res. 2011;127:58–9.

    Article  CAS  PubMed  Google Scholar 

  39. Fasullo S, Maringhini G, Terrazzino G. Thrombolysis for massive pulmonary embolism in pregnancy: a case report. Int J Emerg Med. 2011;4:69–74.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Jerjes-Sánchez C, Ramírez RA, Arriaga NR, Pimentel MG. Dosis altas e infusión rápida de estreptoquinasa para el tratamiento de tromboembolia pulmonar masiva. Arch Inst Cardiol Mex. 1993;63:227–34.

    PubMed  Google Scholar 

  41. Jerjes-Sanchez C, Gutierrez-Fajardo P, Ramirez-Rivera A, Garcia ML, Hernández CHG. Infarto agudo del ventrículo derecho secundario a tromboembolia pulmonar masiva. Arch Inst Cardiol Mex. 1995;65:65–73.

    CAS  PubMed  Google Scholar 

  42. Jerjes-Sanchez C, Ramirez-Rivera A, Garcia ML, Arriaga-Nava R, Valencia-Sanchez S, Rosado-Buzzo A, Pierzo JA, Rosas ME. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis. 1995;2:67–9.

    Article  Google Scholar 

  43. Jerjes-Sanchez C, Ramirez-Rivera A, Arriaga-Nava R, Iglesias-Gonzalez S, Gutierrez P, Ibarra-Perez C, Martinez A, Valencia S, Rosado-Buzzo A, Pierzo JA, Rosas E. High dose and short-term streptokinase infusion in patients with pulmonary embolism. Prospective with seven-year follow-up trial. J Thromb Thrombolysis. 2001;12:237–47.

    Article  CAS  PubMed  Google Scholar 

  44. Jerjes-Sanchez C, Villarreal-Umaña S, Ramirez-Rivera A, Garcia-Sosa A, Canseco LM, Archondo T, Reyes E, Garza A, Arriaga R, Castillo F, Jasso O, Garcia H, Bermudez M, Hernández JM, Garcia J, Martinez P, Rangel F, Gutierrez J, Comparan A. Improving adjunctive treatment in pulmonary embolism and fibrinolytic therapy. The role of enoxaparin and weight-adjusted unfractionated heparin. J Thromb Thrombolysis. 2009;27:154–62.

    Article  CAS  PubMed  Google Scholar 

  45. Pollack CV. The use of oral anticoagulants for the treatment of venous thromboembolic events in an ED. Am J Emerg Med. 2014;32:1526–33.

    Article  PubMed  Google Scholar 

  46. Sharifi M, Bay C, Schwartz F, Skrocki L. Safe-dose thrombolysis plus rivaroxaban for moderate and severe pulmonary embolism. Clin Cardiol. 2014;37:78–82.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Instituto de Cardiologia y Medicina Vascular, TEC Salud, San Pedro Garza Garcia, Nuevo León, Mexico

    Carlos Jerjes-Sánchez M.D., F.C.C.P., F.A.C.C. (Sistema Nacional de Investigadores, Nivel II – Clinical Research Director)

  2. Escuela de Medicina, Tecnológico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico

    Carlos Jerjes-Sánchez M.D., F.C.C.P., F.A.C.C. (Sistema Nacional de Investigadores, Nivel II – Clinical Research Director)

  3. Unidad de Investigacion Clinica en Medicina SC, Monterrey, Nuevo León, Mexico

    Carlos Jerjes-Sánchez M.D., F.C.C.P., F.A.C.C. (Sistema Nacional de Investigadores, Nivel II – Clinical Research Director)

  4. Department of Emergency Room, Hospital de Cardiologia No. 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico

    Anabel Garcia-Sosa M.D.

Authors
  1. Carlos Jerjes-Sánchez M.D., F.C.C.P., F.A.C.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anabel Garcia-Sosa M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Jerjes-Sánchez M.D., F.C.C.P., F.A.C.C. .

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Jerjes-Sánchez, C., Garcia-Sosa, A. (2015). Thrombolysis in Special Situations. In: Thrombolysis in Pulmonary Embolism. Springer, Cham. https://doi.org/10.1007/978-3-319-19707-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19707-4_8

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19706-7

  • Online ISBN: 978-3-319-19707-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation