Seeburun Sheilabi, Valladares Carlos, Iglesias Jose
Department of Internal Medicine, Rutgers Health - Community Medical Center, Toms River, NJ 08755, USA.
Department of Nephrology, Rutgers Health - Community Medical Center, Toms River, NJ 08755, USA.
J Clin Med Res. 2025 Jan;17(1):1-13. doi: 10.14740/jocmr6153. Epub 2025 Jan 14.
Pulmonary embolism (PE) and acute ischemic stroke (AIS) are serious conditions with high morbidity and mortality. In the USA, PE causes around 100,000 deaths annually, with higher incidence in males. AIS following PE occurs in 1-10% of cases and is a leading cause of death within 2 - 4 weeks post-stroke. Managing concurrent PE and AIS is complex due to the need for anticoagulation, which is contraindicated after thrombolysis for AIS. This review evaluates the impact of various PE treatments - anticoagulation, thrombolysis, and embolectomy - on mortality in patients with both conditions. Following PRISMA 2020 guidelines, a systematic review was conducted across six databases from January 2010 to December 2023. The primary outcome measured was mortality, comparing treated vs. untreated patients for PE. Secondary outcomes included marked symptom improvement, slight improvement or deterioration of symptoms, and the complications. Data were analyzed descriptively, summarizing patient demographics, clinical characteristics, and treatment outcomes. Treatment modalities, such as anticoagulation, thrombolysis, catheter-directed thrombectomy, surgical thrombectomy, and conservative management, were evaluated based on their impact on symptom improvement, survival, and mortality. Initial querying of six databases yielded 1,679 articles, with only 21 remaining after a thorough review. Thrombolysis led to 100% symptom improvement and survival, with 0% mortality. Anticoagulation resulted in symptom improvement and survival in 62.5% of cases, with a 12.5% mortality rate. Catheter-directed and surgical thrombectomy had symptom improvement and survival in 66.7% and 75% of cases, respectively, with no mortality. Conservative management, defined here as management without anticoagulation or thrombolytic therapy, was associated with symptom worsening or no improvement and 50% mortality. This systematic review, based on observational data from case reports, highlights the diverse strategies used by physicians. Proactive and aggressive treatments, especially thrombolysis, show better outcomes and lower mortality rates. However, specific recommendations cannot be made from these results alone, emphasizing the need for well-designed prospective, randomized controlled trials to design structured guidelines for healthcare providers.
肺栓塞（PE）和急性缺血性卒中（AIS）是发病率和死亡率都很高的严重疾病。在美国，PE每年导致约10万人死亡，男性发病率更高。PE后发生AIS的病例占1%-10%，是卒中后2-4周内的主要死亡原因。由于需要抗凝治疗，而AIS溶栓后抗凝治疗是禁忌的，因此同时管理PE和AIS很复杂。本综述评估了各种PE治疗方法——抗凝、溶栓和血栓切除术——对这两种疾病患者死亡率的影响。按照PRISMA 2020指南，于2010年1月至2023年12月对六个数据库进行了系统综述。测量的主要结果是死亡率，比较PE治疗组与未治疗组患者。次要结果包括症状明显改善、症状轻微改善或恶化以及并发症。对数据进行描述性分析，总结患者的人口统计学特征、临床特征和治疗结果。根据抗凝、溶栓、导管定向血栓切除术、外科血栓切除术和保守治疗等治疗方式对症状改善、生存和死亡率的影响进行评估。对六个数据库的初步查询产生了1679篇文章，经过全面审查后仅剩下21篇。溶栓治疗使症状改善率和生存率达到100%，死亡率为0%。抗凝治疗使62.5%的病例症状得到改善且存活，死亡率为12.5%。导管定向血栓切除术和外科血栓切除术分别使66.7%和75%的病例症状得到改善且存活，无死亡病例。保守治疗（在此定义为不进行抗凝或溶栓治疗的管理）与症状恶化或无改善以及50%的死亡率相关。基于病例报告的观察数据进行的这项系统综述突出了医生使用的多种策略。积极主动的治疗，尤其是溶栓治疗，显示出更好的结果和更低的死亡率。然而，仅从这些结果无法得出具体建议，这强调了需要设计良好的前瞻性随机对照试验，为医疗保健提供者制定结构化指南。
