Objective To systematically review the effectiveness of amiodarone in treating repurfusion arrhythmia (RA) after thrombolytic therapy for acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational thrombolytic therapy for AMI. Methods Randomized controlled trails (RCTs) on amiodarone in treating RA after thrombolytic therapy for AMI were electronically retrieved in PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CBM, CNKI, VIP and WanFang Data from inception to January, 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs involving 440 patients were included. The results of meta-analysis suggested that, compared with the blank control, amiodarone reduced the incidence of RA after thrombolytic therapy in treating AMI (RR=0.60, 95%CI 0.48 to 0.74, Plt;0.000 01) and the incidence of ventricular fibrillation (RR=0.47, 95%CI 0.26 to 0.85, P=0.01). It neither affected the recanalization rate of occluded arteries after thrombolytic therapy (RR=1.00, 95%CI 0.88 to 1.15, P=0.94) nor decreased the mortality after surgery (RR=0.33, 95%CI 0.10 to 1.09, P=0.07). Conclusion Current evidence indicated that, amiodarone can decrease the incidence of RA. Unfortunately, the mortality rate can’t be reduced by amiodarone. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion
Objective To assess the effect of different thrombolytic agents, and different regimens in acute ischaemic stroke. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed. RCTs were identified from the Cochrane Stroke Group trials register, Embase (1980 to 1997), handsearching Japanese and Chinese journals, and personal contact with pharmaceutical companies. We included randomised and quasi-randomised trials in patients with confirmed acute ischaemic stroke comparing different doses of a thrombolytic agent, or different thrombolytic agent, or the same agent given by different routes. Results Eight trials involving 1 334 patients were included. Concealment of allocation was generally adequate. All the trials were conducted in Japan. Different doses (of tissue plasminogen activator or urokinase) were compared in six trials. Different agents (tissue plasminogen activator versus urokinase,or tissue-cultured urokinase versus conventional urokinase) were compared in three trials. Few data were available for functional outcomes. A higher dose of thrombolytic therapy was associated with a five-fold increase in fatal intracranial haernorrhages (odds ratio 5.02, 95% confidence interval 1.56 to 16.18). There was a non-significant trend towards more early deaths or clinically significant intracranial haemorrhages in higher dose group. No difference in late deaths or extra-cranial haemorrhages was shown between low and higher doses. However, very few of these events occurred. No difference was shown between the different thrombolytic agents tested. Conclusions There is not enough evidence to conclude whether lower doses of thrombolytic agents might be safer or more effective than higher doses in acute ischaemic stroke. It is not possible to conclude whether one agent might be better than another, or which route of administration might be best.
To assess the efficacy and safety of thrombolytic therapy. Electronic search was applied to the Cochrane Airways Group register (MEDLINE, EMBASE, CINAHL standardized searches) with the date up to 2003 April. Hand searched respiratory journals and meeting abstracts. All randomized controlled trials comparing thrombolytic therapy with heparin alone or surgical intervention (eg. embolectomy) met the inclusion criteria. Two reviewers independently selected trials, assessed trial quality and extracted the data.
ObjectiveTo evaluate the treatment effective of deep vein thrombosis (DVT) of low extremities. MethodsThe clinical data of 86 patients with DVT were analyzed retrospectively, which were divided into thromboectomy group (12 patients) and thrombolysis group (74 patients) according to the therapy methods. The thromboectomy group patients were treated by thromboectomy using Fogarty balloon catheter plus thrombolytie, thrombolysis group patients were treated by thrombolysis (urokinase or antithrombus enzyme of viper). ResultsThere were 8 cases healed, 4 cases relieved, 0 invalidated in the thromboectomy group and 15 cases healed, 50 cases relieved, 9 cases invalidated in the thrombolysis group at discharge. During 3-100 months of following up with an average 27 months, 10 cases and 62 cases were examined by Bultrasonic in the thromboectomy group and thrombolysis group, respectively, 6 cases were not damaged in the function of valves of the thromboectomy group, 9 cases were not damaged in the function of valves of the thrombolysis group. The rates of acute response, longtime patency, and normal valve in the thromboectomy group were higher than those in the thrombolysis group (Plt;0.05), the rate of post-thrombotic syndrome in the thromboectomy group was lower than that in the thrombolysis group (Plt;0.05). ConclusionsEarly thromboectomy is an effective way of restoring the fluency of deep vein and protecting the efficiency of the vein value organization, and reducing the sequela of DVT. Thrombolysis can only relieve the symptomation, but it can not protect the crawling and relapsing of thrombus.
Objective To explore the clinical presentation and diagnosis and treatment of prehepatic portal hypertension （PPH） and discuss its surgical strategies. Methods Forty-six cases of PPH treated in the 2nd Artillery General Hospital and Peking Union Medical College Hospital from January 2000 to May 2009 were analyzed retrospectively, including 2 cases of Abernethy abnormality. All patients were evaluated by indirect portal vein angiography, CT angiography and (or) portal duplex system Doppler ultrasonography before treament. Surgical strategies included: 23 cases with meso-caval shunt, 8 cases with splenectomy and spleno-renal vein shunt, 1 case with porta-caval shunt, 2 cases with paraumbilical vein-jugular vein shunt, 3 cases with portal azygous disconnection, 1 cases with splenectomy and portal azygous disconnection, 1 case with sigmoidostomy and closed the fistula of sigmoid six months later, 1 case with resection of part of small intestine due to acute extensive thrombosis of portal vein system, 4 cases with selective superior mesenteric artery and (or) splenic artery thrombolytic infusion therapy, 2 cases remained no-surgical option and underwent conservative treatment. Results Forty-four patients were followed-up from 2 months to 5 years， average of 23.4 months, one patient without surgical treatment was lost. Satisfactory outcomes were obtained in 34 patients with various shunts, which expressed as a release of hypersplenism and gastrointestinal hemorrhage. Two cases were treated with meso-caval shunt because of rehemorrhage in month 13 and 24 and one died in month 8 after disconnection, one died on day 40 after thrombolytic therapy due to putrescence of intestines, one who remained no-surgical option underwent hemorrhage 4 months later, and then went well by conservative treatment. Conclusion The key of treatment of PPH is to reduce the pressure of hepatic portal vein. Surgical managements of shunt and selective superior mesenteric artery and (or) splenic artery thrombolytic infusion therapy are safe and effective, but individual treatment strategy should be performed.
Objective To explore the results of thrombolytic therapy of acute deep vein thrombosis of lower extremity. Methods The clinical data of 126 patients with acute deep vein thrombosis of lower extremity treated conservatively from Dec.1999 to Feb.2004 were analyzed retrospectively. Results All patients were divided into three groups: 26 of central, 33 of surrounding and 67 of combined by Doppler sonography. Combined medication was adopted in all cases, in which 85 cases (67.5%) were clinically cured, 34 cases (27.0%) had good results, and 5 cases (4.0%) recovered partially. Two cases (1.6%) didn’t get better. The total effective rate was 98.4% (124/126). Conclusion Most patients with acute deep vein thrombosis of lower extremity can get satisfied results with conservative treatment including thrombolysis and anticoagulation. Early diagnosis and appropriate medication are crucial.
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
Objective To compare the efficacy of reteplase and ateplase in the treatment of acute massive pulmonary thromboembolism ( PTE) in emergency. Methods From January 2005 to December 2009,42 patients with acute massive PTE were treated by intravenous thrombolysis with reteplase or ateplase. The thrombolysis efficacy, bleeding incidence and mortality were measured. Results In the reteplase group, the emergency thrombolysis effective rate was 88. 9% among 18 patients. Mild bleeding occurred in 3 patients,moderate bleeding in 1 patient, and 2 cases died in hospital. In the ateplase group, the emergency thrombolysis effective rate was 75% among 24 patients. Mild bleeding occurred in 3 patients, moderate bleeding in 2 patients, and 3 cases died in hospital. The thrombolysis effective rate, bleeding incidence and mortality had no significant difference between the two groups. Conclusion Both the reteplase and ateplase thrombolysis therapy are safe and effective in the treatment of acute massive PTE, but reteplase thrombolysis therapy is more convenient in emergency.
Objective To analyze the clinical features of patients with acute pulmonary embolism ( APE) with normal blood pressure and right ventricular dysfunction. Methods 130 hospitalized patients with normotensive APE between January 2009 and January 2012 were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with RVD. The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Results 41 normotensive APE patients with RVD were as RVD group, and other 89 patients without RVD were as non-RVD group. The incidences of syncope ( 34.1% vs. 7.8% ) , tachycardia( 41.4% vs. 21.3% ) , P2 hyperthyroidism( 46.3% vs. 25.8% ) , jugular vein filling ( 12.1% vs. 1.1% ) , and cyanosis ( 26.8% vs. 8.9% ) were all significantly higher in the RVD group than those in the non-RVD group ( P lt; 0.05) . Computed tomography pulmonary angiography ( CTPA) revealed that the incidences of thromboembolism involving proximal pulmonary artery ( 58. 3% vs. 8. 3% ) and thromboembolism involving lobar pulmonary ( 77.8% vs.51.2% ) were also higher in the RVD group ( P lt; 0.001, P = 0.025 ) . In the RVD group, the patients were assigned to received thrombolysis plus anticoagulation therapy, or anticoagulation therapy alone. The clinical indicators ( heart rate, PaCO2 , AaDO2 , SPAP, TRPG) were all statistically improved after thrombolysis or anticoagulation treatment ( P lt;0.001) . But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and the levels of AaDO2 , SPAP and TRPG were statistically lower in the patients with thrombolysis plus anticoagulation therapy. Conclusions For APE patients with central pulmonary embolism demonstrated by CTPA, syncope, and tachycardia, transthoracic echocardiograph should be performed as early as possible to confirm RVD diagnosis. For normotensive APE patients with RVD, anticoagulant treatment can achieve higher efficacy of costeffectiveness ratio.