Therapeutic Strategy of Acute Pulmonary Embolism: Analysis of 48 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHENGJiang-hua ¹ , CHENKai ¹ , DENGJing ² , RENYong-jun ² , YONGXi ¹ , WANGHai-fei ¹ , CHENZhi-long ¹ , ZHUYan-bin ¹

1. Department of Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
2. Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

ZHENGJiang-hua, Email: zhengjianghua@126.com

Keywords：

Acute pulmonary embolism; Therapeutic strategy; Interventional therapy; Anticoagulation; Thrombolysis

DOI：

10.7507/1007-9424.20150080

Video：

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Objective To investigate therapeutic strategy of acute pulmonary embolism. Methods Clinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. Results Of the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. Conclusions Corresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.

Citation： ZHENGJiang-hua, CHENKai, DENGJing, RENYong-jun, YONGXi, WANGHai-fei, CHENZhi-long, ZHUYan-bin. Therapeutic Strategy of Acute Pulmonary Embolism: Analysis of 48 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 297-300. doi: 10.7507/1007-9424.20150080 Copy

1.	中华医学会心血管病学分会肺血管病学组, 中国医师协会心血管内科医师分会. 急性肺血栓栓塞症诊断治疗中国专家共识. 中华内科杂志, 2010, 49(1):74-80.
2.	Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembo-lism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost, 2007, 98(4):756-764.
3.	Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmona embolism:a meta-analysis of the randomized controlled trials. Circulation, 2004, 110(6):744-749.
4.	Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism:the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29(18):2276-2315.
5.	Raschke RA, Reilly BM, Guidry JR, et al. The weight-based heparin dosing nomogram compared with a "standard care" nomogram. A randomized controlled trial. Ann Intern Med, 1993, 119(9):874-881.
6.	Lankeit M, Konstantinides S. Thrombolytic therapy for submassive pulmonary embolism. Best Pract Res Clin Haematol, 2012, 25(3):379-389.
7.	Chalikias G, Konstantinides S. Acute phase treatment of pulmonary embolism. Curr Vasc Pharmacol, 2014, 12(3):393-400.
8.	Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 1999, 353(9162):1386-1389.
9.	Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism:results of a multicenter registry. J Am Coll Cardiol, 1997, 30(5):1165-1171.
10.	Society BT. Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Research Committee of the British Thoracic Society. Lancet, 1992, 340(8824):873-876.
11.	Butler SP, Quinn RJ. The clinical course of pulmonary embolism. N Engl J Med, 1992, 327(13):957-958.
12.	Aujesky D, Jiménez D, Mor MK, et al. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation, 2009, 119(7):962-968.
13.	Laporte S, Mismetti P, Décousus H, et al. Clinical predictors for fatal pulmonary embolism in 15 520 patients with venous thromboembolism:findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation, 2008, 117(13):1711-1716.
14.	Kasper W, Konstantinides S, Geibel A, et al. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart, 1997, 77(4):346-349.
15.	Konstantinides S. Pulmonary embolism:impact of right ventricular dysfunction. Curr Opin Cardiol, 2005, 20(6):496-501.
16.	Mcintyre KM, Sasahara AA. Determinants of right ventricular function and hemodynamics after pulmonary embolism. Chest, 1974, 65(5):534-543.
17.	Miller RL, Das S, Anandarangam T, et al. Association between right ventricular function and perfusion abnormalities in hemodynamically stable patients with acute pulmonary embolism. Chest, 1998, 113(3):665-670.
18.	Greyson C, Xu Y, Cohen J, et al. Right ventricular dysfunction persists following brief right ventricular pressure overload. Cardiovasc Res, 1997, 34(2):281-288.
19.	Schmitto JD, Doerge H, Post H, et al. Progressive right ventricular failure is not explained by myocardial ischemia in a pig model of right ventricular pressure overload. Eur J Cardiothorac Surg, 2009, 35(2):229-234.
20.	Chung T, Connor D, Joseph J, et al. Platelet activation in acute pulmonary embolism. J Thromb Haemost, 2007, 5(5):918-924.
21.	Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism:the pivotal role of pulmonary vasoconstriction. Cardiovasc Res, 2000, 48(1):23-33.
22.	Konstantinides S. Clinical practice. Acute pulmonary embolism. N Engl J Med, 2008, 359(26):2804-2813.
23.	Akin H, Al-Jubouri M, Assi Z, et al. Catheter-directed thrombolytic intervention is effective for patients with massive and submassive pulmonary embolism. Ann Vasc Surg, 2014, 28(7):1589-1594.
24.	Avgerinos ED, Chaer RA. Catheter-directed interventions for acute pulmonary embolism. J Vasc Surg, 2015, 61(2):559-565.
25.	李国剑, 杨国凯, 何晓明, 等. 下腔静脉滤器在治疗下肢深静脉血栓中的应用. 中国普外基础与临床杂志, 2009, 16(11):922-924.

1. 中华医学会心血管病学分会肺血管病学组, 中国医师协会心血管内科医师分会. 急性肺血栓栓塞症诊断治疗中国专家共识. 中华内科杂志, 2010, 49(1):74-80.
2. Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembo-lism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost, 2007, 98(4):756-764.
3. Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmona embolism:a meta-analysis of the randomized controlled trials. Circulation, 2004, 110(6):744-749.
4. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism:the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J, 2008, 29(18):2276-2315.
5. Raschke RA, Reilly BM, Guidry JR, et al. The weight-based heparin dosing nomogram compared with a "standard care" nomogram. A randomized controlled trial. Ann Intern Med, 1993, 119(9):874-881.
6. Lankeit M, Konstantinides S. Thrombolytic therapy for submassive pulmonary embolism. Best Pract Res Clin Haematol, 2012, 25(3):379-389.
7. Chalikias G, Konstantinides S. Acute phase treatment of pulmonary embolism. Curr Vasc Pharmacol, 2014, 12(3):393-400.
8. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 1999, 353(9162):1386-1389.
9. Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism:results of a multicenter registry. J Am Coll Cardiol, 1997, 30(5):1165-1171.
10. Society BT. Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Research Committee of the British Thoracic Society. Lancet, 1992, 340(8824):873-876.
11. Butler SP, Quinn RJ. The clinical course of pulmonary embolism. N Engl J Med, 1992, 327(13):957-958.
12. Aujesky D, Jiménez D, Mor MK, et al. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation, 2009, 119(7):962-968.
13. Laporte S, Mismetti P, Décousus H, et al. Clinical predictors for fatal pulmonary embolism in 15 520 patients with venous thromboembolism:findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation, 2008, 117(13):1711-1716.
14. Kasper W, Konstantinides S, Geibel A, et al. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart, 1997, 77(4):346-349.
15. Konstantinides S. Pulmonary embolism:impact of right ventricular dysfunction. Curr Opin Cardiol, 2005, 20(6):496-501.
16. Mcintyre KM, Sasahara AA. Determinants of right ventricular function and hemodynamics after pulmonary embolism. Chest, 1974, 65(5):534-543.
17. Miller RL, Das S, Anandarangam T, et al. Association between right ventricular function and perfusion abnormalities in hemodynamically stable patients with acute pulmonary embolism. Chest, 1998, 113(3):665-670.
18. Greyson C, Xu Y, Cohen J, et al. Right ventricular dysfunction persists following brief right ventricular pressure overload. Cardiovasc Res, 1997, 34(2):281-288.
19. Schmitto JD, Doerge H, Post H, et al. Progressive right ventricular failure is not explained by myocardial ischemia in a pig model of right ventricular pressure overload. Eur J Cardiothorac Surg, 2009, 35(2):229-234.
20. Chung T, Connor D, Joseph J, et al. Platelet activation in acute pulmonary embolism. J Thromb Haemost, 2007, 5(5):918-924.
21. Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism:the pivotal role of pulmonary vasoconstriction. Cardiovasc Res, 2000, 48(1):23-33.
22. Konstantinides S. Clinical practice. Acute pulmonary embolism. N Engl J Med, 2008, 359(26):2804-2813.
23. Akin H, Al-Jubouri M, Assi Z, et al. Catheter-directed thrombolytic intervention is effective for patients with massive and submassive pulmonary embolism. Ann Vasc Surg, 2014, 28(7):1589-1594.
24. Avgerinos ED, Chaer RA. Catheter-directed interventions for acute pulmonary embolism. J Vasc Surg, 2015, 61(2):559-565.
25. 李国剑, 杨国凯, 何晓明, 等. 下腔静脉滤器在治疗下肢深静脉血栓中的应用. 中国普外基础与临床杂志, 2009, 16(11):922-924.

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Therapeutic Strategy of Acute Pulmonary Embolism: Analysis of 48 Cases

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