- Poster presentation
Is it safe to thrombolyse patients with pulmonary embolism and right heart mobile thrombi?
Critical Care volume 13, Article number: P441 (2009)
Right heart mobile thrombi (RHMT) are not frequent in patients with acute pulmonary embolism (APE); however, bear a significant risk of APE recurrence and hemodynamic compromise. Immediate therapy is recommended, but the optimal approach is considered to be controversial in the absence of controlled trials .
We report an analysis of 21 out of 209 (10%) consecutive patients with echocardiographically diagnosed RHMT managed at our institution during the past 5 years. For demographics, vital signs and laboratory values on entry see Table 1.
Eight (38%) out of 21 patients with RHMT presented with massive, 12 (57%) submassive and one with small APE. Right ventricle overload was detected in 20 out of 21 patients (95%). Fifteen (71%) patients were thrombolysed, three (14%) patients have undergone surgical embolectomy. Thrombolysis was successful in 13 out of 15 (87%) patients, RHMT was dislodged in two patients; in one of them with fatal outcome, the other one was urgently managed by venoarterial extracorporeal membrane oxygenation and subsequently by surgical embolectomy. The 30-day mortality was 10% (n = 2) in RHMT and 6% (n = 11 out of 188) in patients without RHMT.
Systemic thrombolysis is a safe and effective treatment for APE with RHMT. Urgent venoarterial extracorporeal membrane oxygenation as a rescue option for hemodynamic collapse in thrombus dislodgment opens a new therapeutic bridge to further decision and treatment.
Torbicki A, et al.: 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 2008, 29: 2276-2315. 10.1093/eurheartj/ehn475
About this article
Cite this article
Belohlavek, J., Dytrych, V., Kral, A. et al. Is it safe to thrombolyse patients with pulmonary embolism and right heart mobile thrombi?. Crit Care 13 (Suppl 1), P441 (2009). https://doi.org/10.1186/cc7605
- Public Health
- Effective Treatment
- Pulmonary Embolism
- Emergency Medicine
- Significant Risk