Thrombolytic therapy in patients with submassive pulmonary embolism: A systematic review

Authors

  • Donya Kittinaradorn
  • Nichthida Tangnuntachai
  • Nicha Wongjarupong
  • Duangthip Longchit
  • Songphoom Atipookanok
  • Thosaporn Boondarikpornpant
  • Titaporn Nopmaneepaisarn
  • Thipyada Papassornsiri
  • Thanion Soopanit
  • Tanaboon Tantirungsi
  • Thanapat Supakmontri
  • Tanavadee Rattanaphong
  • Tanawin Suksirivoraboot
  • Monvasi Pachinburavan
  • Pisut Katavetin

Keywords:

Thrombolysis, alteplase, submassive PE, right ventricular dysfunction

Abstract

Background : The use of thrombolytic therapy in patients with submassive pulmonary embolism (PE) is still controversial.

Objective : To evaluate the role of thrombolytic therapy in patients with submassive PE. Design Systematic review.

Setting : Faculty of Medicine, Chulalongkorn University.

Methods : We performed a literature search using Pubmed, Scopus, scientific abstracts from meetings, and bibliographies of retrieved articles. Only randomized control trials were included in this systematic review.

Result : Three randomized control trials were identified. All these studies excluded patients with high risk of bleeding. The evidence from randomized control trials identified in this systematic review suggested that thrombolytic therapy in addition to heparin may provide a long-term mortality benefit, prevent clinical deterioration, and preserve right ventricular function with a slightly increased risk of minor bleeding in patients with submassive PE. The benefits of thrombolytic therapy were most obvious in a randomized control trial that enrolled patients within 6 hours after the onset of the symptoms.

Conclusion : Thrombolytic therapy may be considered in patients with submassive PE who have low risk of bleeding complications and present early after the onset of the symptoms.

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Published

2023-09-11

How to Cite

1.
Kittinaradorn D, Tangnuntachai N, Wongjarupong N, Longchit D, Atipookanok S, Boondarikpornpant T, Nopmaneepaisarn T, Papassornsiri T, Soopanit T, Tantirungsi T, Supakmontri T, Rattanaphong T, Suksirivoraboot T, Pachinburavan M, Katavetin P. Thrombolytic therapy in patients with submassive pulmonary embolism: A systematic review. Chula Med J [Internet]. 2023 Sep. 11 [cited 2024 Nov. 6];58(6). Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/679