CC Jan 2016 Thombolysis and Pulmonary Embolism

echoecho's version from 2016-03-20 19:08


Question Answer
Acute pulmonary embolism (PE) is responsible for >_________ deaths annually in the US and is a significant cause of cardiovascular morbidity?100,000
The American College of Chest Physicians (ACCP) published the 9th editon of their antithrombotic guidline in _____, including recommendations concerning the treatment of acute PE with thrombolytic therapy?2012
While randomized trials have established improvements in pulmonary artery hemodynamic measurements, arteriovenous oxygen, pulmonary perfusion and right ventricular wall movement at 24 hours, does thrombolytic therapy appear to reduce the extent of residual thrombus?no
Why do patients with a larger clot burden benefit the most from thrombolysis?because they have the most hemodynamic derangement and the highest mortality (70% in patients with cardiopulmonary arrest vs. 2% in patients who have normal blood pressure)
Evidence concerning the use of thrombolysis in acute PE suggest an association with what 3 factors?1) reduced mortality 2) recurrent PE 3) increase in the risk of major bleeding
*** The authors of the above guidelines concluded that in balancing the potential benefits and the potential risks of thrombolysis in patients with acute PE, thrombolytic therapy is recommended only in what patients?in patients with hypotension, which is defined as SBP < 90
Which other patients are candidates for thrombolytic therapy?those with low bleeding risk and who, based on clinical presentation or course, are at high risk for developing hypotension
Guidelines recommend using a short (___ hour) rather than a long (____ hour) infusion via a peripheral vein?2; 24
What procedure is recommended for patients with contraindications to systemic thrombolysis, failed systemic thrombolysis or shock that is likely to cause death before the several hours that it will take systemic thrombolytics to work?catheter-assisted thrombus
A 2009 Cochrane review compared thrombolytic therapy to anticoagulation for treatment of acute PE. What were the results?1) no significant differences in death rates, recurrence of PE or major or minor hemorrhage between the two groups 2) thrombolytics were associated with improved hemodynamic outcomes, perfusion lung scaning, pulmonary angiogram assessment and echocardiogram results. 3) more studies were needed before thrombolytics could be recommended
A meta-analysis studied the role of thrombolysis vs. anticoagulation acutely in patients with an IMMEDIATE-risk PE (defined as as PE with normotension, right ventircular dysfunction and/or myocardial injury). What were the findings?1) there was no significant differences in the 30-day all-cause mortality between the two groups 2) patients who received thrombolytics had lower rates of clinical deterioration and recurrent PE 3) while minor bleeding was significantly more common in the thrombolytic group, the incidence of major bleeding was similar 4) thrombolytic therapy should be considered for patients with immediate-risk PE and who do not have contraindications to it
At present, the evidence and recommendation is strongest for the use of thrombolytic therapy for PE in what type of patient?hemodynamically unstable patients (hypotensive)
Despite recent evidence showing benefit for less severely ill patients, thrombolysis for these patients should be decided upon based on what?1) bleeding risk 2) individual patient factors (e.g. right ventricular dysfunction, clot burden, hypoxemia)
*** SUMMARY = Patients with larger clot burden have what derangement and mortality rate and potentially stand to benefit the most from thrombolysis?1) most hemodynamic derangement 2) highest mortality rate
*** SUMMARY = Thrombolytic therapy is recommended only in patients with _____ or who are at high risk of developing _____, which is defined as a SBP of < ____mmHg?hypotension; hypotension; 90
*** SUMMARY = Thrombolytic therapy is also an option for patients with ____ bleeding risk who, based on clinical presentation or course, are at high risk for developing _____?low, hypotension