Ata Fateen, Hamad Ibrahim Wanis, Nasser Affas Mohammad, Ahmad Khan Haseeb, Younas Hafiz Waqas, Maat Zakaria, Ali Mohamed Sabah Elshayeb, Daoudi Balqis
Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
Department of Pulmonology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2022 Aug 5;2022(3):33. doi: 10.5339/qmj.2022.33. eCollection 2022.
Thrombolysis is an established therapeutic modality for patients with high-risk (and some selected intermediate-risk) pulmonary embolism (PE) with hemodynamic instability. Physicians sometimes experience cases where both a high-risk PE and thrombocytopenia coexist. Although thrombocytopenia of < 100 × 10/mm is considered a contraindication in patients with ischemic stroke, the safety and outcomes of thrombolysis in patients with acute PE and thrombocytopenia are unknown. This systemic review aimed to pool data on the safety and outcomes of thrombolysis use in patients with PE and platelet count less than 150 × 10/mm. Patients' demographics, clinical characteristics, management, type of thrombolytic therapy, and outcomes were extracted and analyzed. Of 283 articles identified through the systematic search, 11 case reports fulfilled the inclusion criteria. The mean age of the patients was 52.27 years, and 54.5% were women. The median platelet level before thrombolysis was 65.50 × 10/mm. Before thrombolysis was initiated, the lowest and highest platelet levels were 29 × 10/mm and 105 × 10/mm, respectively. Alteplase was used in 10 patients and urokinase in one patient. One patient who had a massive PE died of aspiration pneumonia. Interestingly, no thrombocytopenia-related complications were reported. This systematic review highlights the potential benefits and safety of thrombolysis in patients with acute PE in the context of thrombocytopenia. Nevertheless, data available in the literature concerning this topic are scarce and limited to case reports. More extensive studies on the use of thrombolysis in patients with PE and thrombocytopenia are desperately needed. Systematic review registration: The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021286415.
溶栓治疗是血流动力学不稳定的高危（以及部分选定的中危）肺栓塞（PE）患者既定的治疗方式。医生有时会遇到高危PE和血小板减少症并存的病例。虽然血小板计数<100×10⁹/mm被认为是缺血性中风患者的溶栓治疗禁忌证，但急性PE合并血小板减少症患者进行溶栓治疗的安全性和疗效尚不清楚。本系统评价旨在汇总血小板计数低于150×10⁹/mm的PE患者使用溶栓治疗的安全性和疗效数据。提取并分析了患者的人口统计学特征、临床特征、治疗管理、溶栓治疗类型及疗效。通过系统检索确定的283篇文章中，有11篇病例报告符合纳入标准。患者的平均年龄为52.27岁，54.5%为女性。溶栓前血小板水平中位数为65.50×10⁹/mm。在开始溶栓治疗前，最低和最高血小板水平分别为29×10⁹/mm和105×10⁹/mm。10例患者使用了阿替普酶，1例患者使用了尿激酶。1例大面积PE患者死于吸入性肺炎。有趣的是，未报告与血小板减少相关的并发症。本系统评价强调了在血小板减少情况下，急性PE患者进行溶栓治疗的潜在益处和安全性。然而，关于该主题的文献资料稀少，且仅限于病例报告。迫切需要对PE合并血小板减少症患者使用溶栓治疗进行更广泛的研究。系统评价注册情况：该方案已在国际系统评价前瞻性注册库（PROSPERO）注册：CRD42021286415。
