Department of Pharmacy, University Medical Center Brackenridge, Seton Family of Hospitals, Austin, Texas 78703, USA.
Pharmacotherapy. 2012 Feb;32(2):158-72. doi: 10.1002/PHAR.1051.
Acute pulmonary embolism is a common complication in hospitalized patients, spanning multiple patient populations and crossing various therapeutic disciplines. Due to the heterogeneous clinical manifestations, the selection of management strategies for patients with acute pulmonary embolism is a challenge for clinicians, and a nuanced understanding of the relevant literature is required. Previous studies that evaluated thrombolytic therapy in patients with acute pulmonary embolism are limited and controversial. Thus, we sought to identify the clinical controversies related to thrombolytic therapy in acute pulmonary embolism and reviewed the recent literature that impacts clinical practice. To apply these controversies into daily clinical practice and decision making, we provide an overview of risk stratification and assessment of pulmonary embolism. Specific areas of controversies that are discussed relate to the impact of thrombolytic therapy on outcomes, specifically in submassive pulmonary embolism, including mortality, composite primary end points, and intensive care unit length of stay. Other controversies relate to the impact of the patient's sex on outcomes, the most safe and effective thrombolytic dose, optimal administration techniques including infusion duration or concurrent anticoagulation, and therapeutic strategies when thrombolytic therapy is unsuccessful. Despite published guidelines and review articles, select aspects of thrombolytic therapy for the management of pulmonary embolism remain controversial; therefore, clinical practice varies from institution to institution and from practitioner to practitioner. When making decisions about the role of thrombolytic therapy in patients with pulmonary embolism, clinicians must be knowledgeable about areas with limited evidence and the therapy's associated risks. In every situation, practitioners must consider the trajectory of the patient's status and the ability to intervene in an appropriate time frame.
急性肺栓塞是住院患者的常见并发症，涉及多个患者群体和多种治疗学科。由于临床表现存在异质性，急性肺栓塞患者的管理策略选择对临床医生来说是一个挑战，需要对相关文献有细致的了解。之前评估急性肺栓塞患者溶栓治疗的研究有限且存在争议。因此，我们试图确定与急性肺栓塞溶栓治疗相关的临床争议，并综述了影响临床实践的最新文献。为了将这些争议应用于日常临床实践和决策中，我们对肺栓塞的风险分层和评估进行了概述。讨论的具体争议领域涉及溶栓治疗对结局的影响，特别是在亚大块肺栓塞中，包括死亡率、复合主要终点和重症监护病房住院时间。其他争议涉及患者性别对结局的影响、最安全有效的溶栓剂量、包括输注时间或同时抗凝的最佳给药技术，以及溶栓治疗失败时的治疗策略。尽管有已发表的指南和综述文章，但溶栓治疗在肺栓塞管理中的某些方面仍存在争议；因此，临床实践因机构和医生而异。在决定溶栓治疗在肺栓塞患者中的作用时，临床医生必须了解证据有限的领域和治疗相关的风险。在每种情况下，医生必须考虑患者病情的发展轨迹和在适当时间范围内进行干预的能力。
