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New Concepts in Thrombolysis of Pulmonary Embolism

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Book cover Fibrinolytics and Antifibrinolytics

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 146))

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Abstract

Venous thromboembolism continues to be a major health problem, arising mainly as a complication of the immobilized hospital patient, but which also occurs in ambulant, otherwise healthy individuals. The incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) have been estimated in a number of epidemiological surveys dealing with a variety of data sources, all of which are probably gross underestimates of the true occurrence rates. Some years ago it was estimated, on the basis of hospital statistics in the United States in 1966, that the total number of diagnosed cases of PE was about 106 000 and the total number of diagnosed cases of DVT was about 182 000 (Hume et al. 1970). Thus according to this estimate there were about a quarter of a million patients diagnosed with DVT and/or PE in the United States in 1966. A longitudinal study by Coon et al. (1973), on the prevalence and incidence of venous thromboembolism in a Michigan community, provides additional epidemiological information. Data derived from this community was extrapolated to the 1970 U.S. census figures to arrive at an estimate of the annual incidence of DVT in the U.S. of over 250 000 cases. In addition, data from this study were used to estimate the prevalence of the postthrombotic sequellae in the U.S. population. The approximate frequency of stasis changes in the skin of the legs was 6–7 million persons, while about 500 000 have or have had leg ulcers. These figures for the prevalence of the post-thrombotic changes would represent a frequency of about 5% of the U.S. adult population.

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References

  • Bell WR (1975) Thrombolytic therapy: a comparison between urokinase and streptokinase. Semin Thromb Hemost 2:1–5

    PubMed  CAS  Google Scholar 

  • Brady AJ, Crake T, Oakley CM (1991) Percutaneous catheter fragmentation and distal dispersion of proximal pulmonary embolus. Lancet 338:1186–1189

    Article  PubMed  CAS  Google Scholar 

  • Come PC, Kim D, Parker JA, Goldhaber SZ, Braunwald E, Markis JE (1987) Early reversal of right ventricular dysfunction in patients with acute pulmonary embolism after treatment with intravenous tissue plasminogen activator. J Am Coll Cardiol 10:971–978

    Article  PubMed  CAS  Google Scholar 

  • Coon WW, Willis PW, Keller JB (1973) Venous thromboembolism and other venous disease in the Tecumseh Community Health Study. Circulation 48:846

    Article  Google Scholar 

  • Covarrubias EA, Sheikh MU, Fox LM (1977) Echocardiography and pulmonary embolism. Ann Int Med 87:720–725

    PubMed  CAS  Google Scholar 

  • Credo RB, Burke SE, Barker WM, Schulz GA, Feibel JM, Henkin J, Sasahara AA (1997a) Recombinant urokinase (r UK): biochemistry, pharmacology, and clinical experience. In: Sasahara A, Loscalzo J (eds) New therapeutic agents in thrombosis and thrombolysis. Marcel Dekker, New York, pp 513–537

    Google Scholar 

  • Credo RB, Burke SE, Barker WM, Villiard EM, Sweeny JM, Henkin J, Sasahara AA (1997b) Recombinant glycosylated pro-urokinase: biochemistry, pharmacology, and early clinical experience. In: Sasahara AA, Loscalzo J (eds) New therapeutic agents in thrombosis and thrombolysis. Marcel Dekker, New York, pp 561–589

    Google Scholar 

  • Cross FS, Mowlem A (1967) A survey of the current status of pulmonary embolectomy for massive pulmonary embolism. Circulation 35 [Suppl 1]:186–191

    Article  Google Scholar 

  • Dalen JE, Alpert JS, Hirsh J (1997) Thrombolytic therapy for pulmonary embolism: is it effective? Is it safe? When is it indicated? Arch Intern Med 157:2550–2556

    Article  PubMed  CAS  Google Scholar 

  • Dalla-Volta S, Palla A, Santolicandro A, Giuntini C, Pengo V, Visioli O, Zonzin P, Zanuttini D, Barbaresi F, Agnelli G, Morpurgo M, Marini MG, Visani L (1992) PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen Activator Italian Multicenter Study 2. J Am Coll Cardiol 20:520–526

    Article  PubMed  CAS  Google Scholar 

  • Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral F, Huet Y, Simonneau G, for the Prevention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group (1998) A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 338:409–415

    Article  PubMed  CAS  Google Scholar 

  • Dickie KJ, Groot WJ, Cooley RN, Bond TP, Guest MM (1974) Hemodynamic effects of bolus infusion of urokinase in pulmonary thromboembolism. Am Rev Respir Dis 109:48–56

    PubMed  CAS  Google Scholar 

  • Diehl J-L, Meyer G, Igual J, Collignon MA, Giselbrecht M, Even P, Sors H (1992) Effectiveness and safety of bolus administration of alteplase in massive pulmonary embolism. Am J Cardiol 70:1477–1480

    Article  PubMed  CAS  Google Scholar 

  • Gisselbrecht M, Diehl JL, Meyer G, Collignon MA, Sors H (1996) Clinical presentation and results of thrombolytic therapy in older patients with massive pulmonary embolism: a comparison with non-elderly patients. J Am Geriatr Soc 44:189–193

    PubMed  CAS  Google Scholar 

  • Goldhaber SZ (1998) Pulmonary embolism. N Engl J Med 339:93–104

    Article  PubMed  CAS  Google Scholar 

  • Goldhaber SZ, Agnelli G, Levine NIN (1994) Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. Chest 106:718–724

    Article  PubMed  CAS  Google Scholar 

  • Goldhaber SZ, de Rosa M, Visani L (1997) International cooperative pulmonary embolism registry detects high mortality rate. Circulation 96 [Suppl I]:1–159 (Abstract)

    Article  Google Scholar 

  • Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, Taveira da Silva AM, Come PC, Lee I, Parker JA, et al (1993) Alteplase versus heparin in acute pulmonary embolism: randomized trial assessing right-ventricular function and pulmonary perfusion. Lancet 341:507–511

    Article  PubMed  CAS  Google Scholar 

  • Goldhaber SZ, Heit J, Sharma GVRK, Nagel JS, Kim D, Parker JA, Drum D, Reagan K, Anderson J, Kessler CN/1, Markis J, Dawley D, Meyerovitz M, Vaughan DE, Turneh SS, Loscalzo J, Selwyn AP, Braunwald E (1988) Randomized controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 2:291–298

    Google Scholar 

  • Goldhaber SZ, Kessler CM, Heit JA, Elliott CG, Friedenberg WR, Heiselman DE, Wilson DB, Parker JA, Bennett D, Feldstein ML, Selwyn AP, Kim D, Sharma GVRK, Nagel JS, Meyerovitz; MF (1992) Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: A randomized controlled multicenter trial. J Am Coll Cardiol 20:24–30

    Article  PubMed  CAS  Google Scholar 

  • Goldhaber SZ, Meyerovitz MF, Markis JE, Kim D, Kessler CM, Sharma GVRK, Vaughan DE, Selwyn AP, Dawley DL, Loscalzo J, Sasahara AA, Grossbard EB, Braunwald E (1987) Thrombolytic therapy of acute pulmonary embolism: current status and future potential. J Am Coll Cardiol 10:9613–10413

    Article  Google Scholar 

  • Goldhaber SZ, Vaughan DE, Markis JE, Selwyn AP, Meyerowitz MF, Loscalzo J, Kim DS, Kessler CM, Dawley DL, Sharma GVRK, Sasahara A, Grossbard EB, Braunwald E (1986) Acute pulmonary embolism treated with tissue plasminogen activator. Lancet 2:886

    Article  PubMed  CAS  Google Scholar 

  • Goldhaber SZ, Visani L, de Rosa M, for ICOPER (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389

    Article  PubMed  CAS  Google Scholar 

  • González-Juanatey JR, Valdés L, Amaro A, Iglesias C, Alvarez D, Acuña JMG, De la Peña MG (1992) Treatment of massive pulmonary thromboembolism with low intrapulmonary dosages of urokinase. Short-term angiographic and hemodynamic evolution. Chest 102:341–346

    Article  PubMed  Google Scholar 

  • Gulba DC, Schmid C, Borst H-G, Lichtlen P, Dietz H, Luft FC (1994) Medical compared with surgical treatment for massive pulmonary embolism. Lancet 343:578–577

    Article  Google Scholar 

  • Gurewich V, Thomas DP, Rabinov KR (1966) Pulmonary embolism after ligation of the inferior vena cava. N Engl J Med 274:1350–1354

    Article  PubMed  CAS  Google Scholar 

  • Hume M, Sevitt S, Thomas DP (1970) Venous Thrombosis and Pulmonary Embolism. Harvard University Press, Cambridge MA

    Google Scholar 

  • Kakkar VV (1973) Results of streptokinase therapy in deep vein thrombosis. Postgrad Med J 49 [August Suppl]:60–67

    Google Scholar 

  • Kanter DS, Mikkola KNI, Patel SR, Parker JA, Goldhaber SZ (1997) Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest I 11:1241–1245

    Article  Google Scholar 

  • Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, Rauber K, Iversen S, Redecker M, Kienast J (1997) Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 30:1165–1171

    Article  PubMed  CAS  Google Scholar 

  • Kasper W, Meinertz T, Henkel B, Eissner D, Hahn K, Hofmann T, Zeiher A, Just H (1986) Echocardiographic findings in patients with proved pulmonary embolism. Am Heart J 112:1284–1290

    Article  PubMed  CAS  Google Scholar 

  • Koning R, Cribier A, Gerber L, Eltchaninoff H, Tron C, Gupta V, Soyer R, Letac B (1997) A new treatment for severe pulmonary embolism: percutaneous rheolytic thrombectomy. Circulation 96:2498–2500

    Article  PubMed  CAS  Google Scholar 

  • Konstantinides S, Geib IA, Olschewski M, Heinrich F, Grosser K, Rauber K, Iversen S, Redecker M, Kienast J, Just H, Kasper W (1997) Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 96:882–888

    Article  PubMed  CAS  Google Scholar 

  • Konstantinides S, Tiede N, Geibel A, Olschewski M, Just H, Kasper W (1998) Comparison of alteplase versus heparin for resolution of major pulmonary embolism. Am J Cardiol 82:966–970

    Article  PubMed  CAS  Google Scholar 

  • Levine M, Hirsh J, Weitz J, Cruickshank M, Neemeh J, Turpie AG, Gent M (1990) A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest 98:1473–1479

    Article  PubMed  CAS  Google Scholar 

  • Lorch H, Welger D, Wagner V, Hillner B, Strecker EP, Herrmann H, Voshage G, Zur C, Schwarzbach C, Schroder J, Gullotta U, Pleissner J, Huttner S, Siering U, Marcklin C, Chavan A, Glaser F, Apitzsch DE, Moubayed K, Leonhardi J, Schuchard UM, Weiss HD, Zwaan M (2000) Current practice of temporary vena cava filter insertion: a multicenter registry. J Vase Interv Radiol 11:83–88

    Article  CAS  Google Scholar 

  • McCotter CJ, Chiang KS, Fearrington EL (1999) Intrapulmonary artery infusion of urokinase for treatment of massive pulmonary embolism: a review of 26 patients with and without contraindications to systemic thrombolytic therapy. Clin Cardiol 22:661–664

    Article  PubMed  CAS  Google Scholar 

  • McIntyre KM, Sasahara AA (1972) Pulmonary angiography, scanning and hemodynamics in pulmonary embolism. Critical review and correlations. CRC Crit Rev Radiol Sci 3:489

    PubMed  CAS  Google Scholar 

  • Meneveau N, Schiele Metz D, Valette B, Attali P, Vuillemenot A, Grollier G, Elaerts J, Mossard J-M, Viel J-F, Bassand J-P (1998) Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up. J Am Coll Cardiol 31:1057–1063

    Article  PubMed  CAS  Google Scholar 

  • Meneveau N, Schiele F, Willernenot A, Valette B, Grollier G, Bernard Y, Bassand JP (1997) Streptokinase vs alteplase in massive pulmonary embolism. A randomized trial assessing right heart hemodynamics and pulmonary vascular obstruction. Eur Heart J 18:1141–1148

    Article  PubMed  CAS  Google Scholar 

  • Meyer G, Sors H, Charbonnier B, Kasper W, Bassand JP, Kerr IH, Lesaffre E, Vanhove P, Verstraete M (1992) Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: a European multicenter double-blind trial. J Am Coll Cardiol 19:239–245

    Article  PubMed  CAS  Google Scholar 

  • Mikkola KM, Patel S, Parker JA, Grodstein F, Goldhaber SZ (1997) Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J 134:69–72

    Article  PubMed  CAS  Google Scholar 

  • Murphy JM, Mulvihill N, Mulcahy D, Foley B, Smiddy P, Molloy MP (1999) Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism. Eur Radiol 9:959–964

    Article  PubMed  CAS  Google Scholar 

  • Petitpretz P, Simmoneau G, Cerrina J, Musset D, Dreyfus M, Vandenbroek MD, Duroux P (1984) Effects of a single bolus of urokinase in patients with life-threatening pulmonary emboli: a descriptive trial. Circulation 70:861–866

    Article  PubMed  CAS  Google Scholar 

  • Sasahara AA (1975) Current problems in pulmonary embolism: Introduction. In: Sasahara AA, Sonnenblick EH, Lesch M (eds) Pulmonary embolism. Grune & Stratton, New York, pp 1–8

    Google Scholar 

  • Sasahara AA, Barsamian EM (1973) Another look at pulmonary embolectomy. Ann Thorac Surg 16:317–320

    Article  PubMed  CAS  Google Scholar 

  • Sasahara AA, Bell WR, Simon TL, Stengle JM, Sherry S (1975) The phase II urokinase streptokinase pulmonary embolism trial: a national cooperative study. Thromb Diath Haemorrh 33:464–476

    Google Scholar 

  • Sasahara AA, Cannilla JE, Morse RL, Tremblay GM (1967) Clinical and physiologic studies in pulmonary thromboembolism. Am J Cardiol 20:10–20

    Article  PubMed  CAS  Google Scholar 

  • Sasahara AA, Hyers TM, Cole CM, Wenger N, Ederer F, Stengle JM, Murray JA, Sherry S (1973) The urokinase pulmonary embolism trial: A national cooperative study. Circulation 47 (Suppl II):1–98

    Article  Google Scholar 

  • Sasahara AA, Sharma GVRK (1988) Thrombolytic therapy in the treatment of pulmonary embolism: short and long-term benefits. In: Comerota AJ (ed) Thrombolytic therapy. Grune and Stratton, Orlando, pp 51–63

    Google Scholar 

  • Sautter RD, Myers WO, Ray JF, Wenzel FJ (1975) Pulmonary embolectomy: review and current status. In: Sasahara A, Sonnenblick EH, Lesch M (eds) Pulmonary embolism. Grune & Stratton, New York, pp 143–161

    Google Scholar 

  • Sautter RD, Myers WO, Wenzel FJ (1972) Implications of the urokinase study concerning the surgical treatment of pulmonary embolism. J. Thorac Cardiovasc Surg 63:54–60

    PubMed  CAS  Google Scholar 

  • Sevitt S, Gallagher NG (1961) Venous thrombosis and pulmonary embolism. A clinico-pathological study in injured and burned patients. Brit J Surg 48:475–479

    Article  PubMed  CAS  Google Scholar 

  • Sharafuddin MJ, Hicks ME (1997) Current status of percutaneous mechanical thrombectomy. 1. General principles. J Vase Interv Radiol 8:911–921

    Article  CAS  Google Scholar 

  • Sharafuddin MJ, Hicks ME (1998a) Current status of percutaneous mechanical thrombectomy. 2. Devices and mechanisms of action. J Vase Interv Radiol 9:15–31

    Article  CAS  Google Scholar 

  • Sharafuddin MJ, Hicks ME (1998b) Current status of percutaneous mechanical thrombectomy. 3. Present and future applications. J Vase Interv Radiol 9:209–224

    Article  CAS  Google Scholar 

  • Sharma GVRK, Burleson VA, Sasahara AA (1980) Effect of thrombolytic therapy on pulmonary capillary blood volume in patients with pulmonary embolism. N Engl J Med 303:842–845

    Article  PubMed  CAS  Google Scholar 

  • Sharma GVRK, Folland ED, McIntyre KM, Sasahara AA (1990) Long term hemodynamic benefit of thrombolytic therapy in pulmonary embolic disease. J Am Coll Cardiol 15:652–845

    Article  Google Scholar 

  • Sharma GVRK, O’Donnell DJ, Belko JS, Sasahara AA (1977) Thrombolytic therapy in deep vein thrombosis. In: Paoletti R, Sherry S (eds) Thrombosis and urokinase. Academic Press, London, pp 181–189

    Google Scholar 

  • Shiina A, Kondo K, Kawai N, Hosada S (1980) Echocardiographic manifestations of acute pulmonary thromboembolism. A case report. Jpn Heart J 22:853

    Article  Google Scholar 

  • Siddique RM, Siddique MI, Connors AF, Rimm AA (1996) Thirty-day case-fatality rates for pulmonary embolism in the elderly. Arch Intern Med 156:2343–2347

    Article  PubMed  CAS  Google Scholar 

  • Sors H, Pacouret G, Azarian R, Meyer G, Charbonnier B, Simonneau G (1994) Hemodynamic effects of bolus vs 2-h infusion of alteplase in acute massive pulmonary embolism. A randomized controlled multicenter trial. Chest 106:712–717

    Article  PubMed  CAS  Google Scholar 

  • Steckley R, Smith CW, Robertson RM (1978) Acute right ventricular overload. An echocardiographic clue to pulmonary thromboembolism. Johns Hopkins Med J 143:122

    PubMed  CAS  Google Scholar 

  • Tebbe U, Graf A, Kamke W, Zahn R, Forycki F, Kratzsch G, Berg G (1999) Hemodynamic effects of double bolus reteplase versus alteplase infusion in massive pulmonary embolism. Am Heart J 138:39–44

    Article  PubMed  CAS  Google Scholar 

  • The PIOPED Investigators (1990) Tissue plasminogen activator for the treatment of acute pulmonary embolism. Chest 97:528–533

    Article  Google Scholar 

  • The UKEP Study Research Group (1987) The UKEP study multicentre clinical trial on two local regimens of urokinase in massive pulmonary embolism. Europ Heart J 8:2–10

    Google Scholar 

  • Urokinase-Streptokinase Pulmonary Embolism Trial (USPET) (1974) Phase 2 results. JAMA 229:1606–1612

    Article  Google Scholar 

  • Verstraete M, Miller GAH, Bounameaux H, Charbonnier B, Colle JP, Lecorf G, Marbet GA, Mornbaerts P, Olsson CG (1988) Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism. Circulation 77:353–360

    Article  PubMed  CAS  Google Scholar 

  • Wheeler HB, Mullick C, Anderson JN, Pearson D (1971) Diagnosis of occult deep vein thrombosis by a noninvasive bedside technique. Surgery 70:20–28

    PubMed  CAS  Google Scholar 

  • Wolfe WG, Sabiston DC Jr (1980) In: Wolfe WG (ed) Pulmonary embolism. Saunders, Philadelphia, p 35

    Google Scholar 

  • Zwaan M, Lorch H, Kulke C, Kagel C, Schweider G, Siemens HJ, Müller G, Eberhardt I, Wagner T, Weiss H-D (1998) Clinical experience with temporary vena caval filters. J Vase Interv Radiol 9:594–601

    Article  CAS  Google Scholar 

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  1. A. A. Sasahara
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  2. G. V. R. K. Sharma
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  1. FRAT — Hôpital Nestlé 2077, CHUV, CH-1011, Lausanne, Switzerland

    F. Bachmann

  2. Chemin Praz Mandry 20, CH-1052, Le Mont, Switzerland

    F. Bachmann

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Sasahara, A.A., Sharma, G.V.R.K. (2001). New Concepts in Thrombolysis of Pulmonary Embolism. In: Bachmann, F. (eds) Fibrinolytics and Antifibrinolytics. Handbook of Experimental Pharmacology, vol 146. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56637-0_12

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