Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy.
Division of Cardiology, Rovigo General Hospital, Rovigo, Italy.
J Thromb Thrombolysis. 2019 Aug;48(2):323-330. doi: 10.1007/s11239-019-01867-0.
Hemodynamically unstable pulmonary embolism (PE) represents a complex and life-threatening event with a highly variable course and poor prognosis in the short-term period. Despite an immediate reperfusion treatment is recommended in these patients, previous investigations have reported a lower use of systemic thrombolysis (ST). The aim of the present review is to assess and describe the real use of ST in hemodynamically unstable patients with acute PE enrolled in prospective-multicenter registries between the 1990 and 2018. Over that period, 1216 articles were identified in Pubmed. After excluding the duplicates obtained using the different searching MeSH (n = 703), 513 articles were screened and then excluded for not meeting inclusion criteria due the article type, design of the study or no English language. As result, 13 articles were assessed for eligibility and carefully reviewed. Finally, five studies met the inclusion criteria and were included in the analysis. The identified study registries enrolled prospectively 41364 consecutive patients with acute PE between the 1993 and the 2016. Among these, 2168 (5.2%) were hemodynamically unstable at presentation. ST was administered in 29.7% (n = 645) of patients while catheter-direct treatment (CDT) was used only in 1.4% (n = 32) of cases. Conversely, surgical pulmonary embolectomy (SPE) was adopted as reperfusion treatment in 39 patients (1.7%). Intriguingly, the 68% of patients not received a reperfusion treatment despite they were hemodynamically unstable at admission. Despite the internationals guidelines recommendations, a prompt reperfusion is performed only in one on three hemodynamically unstable patients with acute PE.
血流动力学不稳定的肺栓塞 (PE) 是一种复杂且危及生命的事件，其病程变化多样，短期预后较差。尽管这些患者应立即进行再灌注治疗，但先前的研究报告显示，全身溶栓治疗 (ST) 的使用率较低。本综述的目的是评估和描述在 1990 年至 2018 年期间，前瞻性多中心注册研究中纳入的血流动力学不稳定的急性 PE 患者中 ST 的实际应用。在此期间，在 Pubmed 中确定了 1216 篇文章。排除使用不同搜索 MeSH 获得的重复项 (n = 703) 后，筛选了 513 篇文章，然后根据文章类型、研究设计或非英语语言将其排除在外，不符合纳入标准。结果，有 13 篇文章符合入选标准并进行了仔细审查。最后，有 5 项研究符合纳入标准并纳入分析。确定的研究登记处前瞻性地纳入了 1993 年至 2016 年间连续 41364 例急性 PE 患者。其中，2168 例 (5.2%) 患者在就诊时血流动力学不稳定。在 645 例 (29.7%) 患者中给予 ST，而仅在 32 例 (1.4%) 患者中使用导管直接治疗 (CDT)。相反，39 例患者 (1.7%) 采用手术肺动脉血栓切除术 (SPE) 作为再灌注治疗。有趣的是，尽管患者入院时血流动力学不稳定，但 68%的患者未接受再灌注治疗。尽管有国际指南的推荐，但在血流动力学不稳定的急性 PE 患者中，只有三分之一的患者能得到及时的再灌注治疗。
