Pulmonary embolism (PE) is a relatively common life-threatening cardiovascular condition associated with significant morbidity and mortality. We present the efficacy and safety data of weight-adjusted tenecteplase in 30 consecutive patients of acute PE. 30 patients (22 male, 8 female) with acute PE were included in the study and divided into three groups: (1) Acute PE complicated by shock stage and/or persistent hypotension (12 patients). (2) RV dilatation and/or dysfunction without hypotension (14 patients). (3) Severe hypoxemia without hypotension and RV dysfunction (4 patients). Predominant symptoms were dyspnoea, cough, chest pain, syncope and haemoptysis, noted in 100% (30), 40% (12), 54% (16), 32% (9) and 10% (3) of patients respectively. RV dilatation and dyskinesia were present in 86%, septal paradoxical movement in 73% and inferior venacava collapse absent in 53% of patients respectively. 12 patients presented with acute PE and cardiogenic shock, 14 patients showed RV dilatation and dysfunction with systolic BP >90 mmHg and four patients were having RV dilation without dysfunction but severe hypoxemia. There was significant reduction in right ventricular systolic pressure and improvement in right ventricular dysfunction. Our study shows that tenecteplase is very effective and safe in the treatment of PE with minimal risk of bleeding in high risk group and intermediate risk and even in selective low risk category group of patients. However, in view of small number of patients in study group, a large multicentre randomized study would be required to draw a firm conclusion regarding the thrombolysis in low risk category patient.

译文

:肺栓塞(PE)是一种相对常见的威胁生命的心血管疾病,与高发病率和高死亡率相关。我们提供体重调整的替奈普酶在30例急性PE患者中的疗效和安全性数据。本研究包括30例急性PE的患者(男22例,女8例),分为三组:(1)伴有休克期和/或持续性低血压的急性PE(12例)。 (2)无低血压的RV扩张和/或功能障碍(14例)。 (3)严重低氧血症,无低血压和RV功能障碍(4例)。主要症状是呼吸困难,咳嗽,胸痛,晕厥和咯血,分别在100%(30),40%(12),54%(16),32%(9)和10%(3)的患者中注意到。分别有86%的患者存在RV扩张和运动障碍,73%的患者出现室间隔自相矛盾,53%的患者无下腔静脉塌陷。 12例表现为急性PE和心源性休克的患者,14例表现为RV扩张和功能障碍,收缩压> 90 mmHg,4例表现为RV扩张,无功能障碍但严重低氧血症。右心室收缩压明显降低,右心室功能障碍改善。我们的研究表明,替奈普酶在治疗PE方面非常有效和安全,在高危组和中危组甚至选择性低危组的患者中出血风险最小。但是,鉴于研究组中的患者人数较少,需要进行一项大型,多中心的随机研究,以得出有关低风险类别患者溶栓的坚定结论。

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