Emergency Department People's Hospital of Peking University, China.
Am J Emerg Med. 2018 Aug;36(8):1522.e5-1522.e7. doi: 10.1016/j.ajem.2018.04.035. Epub 2018 Apr 19.
Massive pulmonary embolism (PE) is defined by acute PE with sustained systemic arterial hypotension that is below 90 mm Hg for at least 15 min or requires inotropic agents (Jaff et al., 2011). For patients with absolute contraindications to thrombolysis, interventional treatment requires the removal of obstructing thrombi from the main pulmonary arteries to facilitate RV recovery and improve symptoms and survival (European Respiratory Society et al., 2014). For patients with acute PE, anticoagulation is recommended, with the objective of preventing both early death and recurrent symptomatic or fatal VTE. Rivaroxaban, an oral factor Xa inhibitor and a new oral anticoagulants, shows effective anticoagulation within hours of administration. It has a fixed-dose regimen, and requires no laboratory monitoring (EINSTEIN-PE Investigators et al., 2012). However, the efficacy and safety of rivaroxaban plus catheter-directed treatment for massive PE and bleeding is unknown. This case demonstrated that a combination of catheter-directed treatment and rivaroxaban was safe and effective in for the treatment of severe PE with vaginal bleeding.
大面积肺栓塞（PE）的定义为急性 PE 伴有持续的全身动脉低血压，至少 15 分钟内血压低于 90mmHg 或需要正性肌力药物（Jaff 等人，2011）。对于绝对不能溶栓的患者，介入治疗需要从主肺动脉中清除阻塞的血栓，以促进 RV 恢复，改善症状和生存率（欧洲呼吸学会等，2014）。对于急性 PE 患者，建议抗凝治疗，目的是预防早期死亡和复发性有症状或致命的 VTE。利伐沙班，一种口服 Xa 因子抑制剂和一种新型口服抗凝剂，在给药数小时内即可有效抗凝。它具有固定剂量方案，不需要实验室监测（EINSTEIN-PE 研究者等，2012）。然而，利伐沙班加导管导向治疗大面积 PE 和出血的疗效和安全性尚不清楚。本病例表明，导管导向治疗联合利伐沙班治疗阴道出血的严重 PE 是安全有效的。
