Evolving paradigm of thrombolysis in pulmonary embolism:Comprehensive review of clinical manifestations,indications,recent advances and guideline  

作　　者：Rohan Kumar Ochani Rafi Aibani Hafsa Nazir Jatoi Masroor Anwar Syed Anjum Khan Iqbal Ratnani Salim Surani 

机构地区：[1]Department of Internal Medicine,Dow University of Health Science,Karachi 74200,Sindh,Pakistan [2]Department of Internal Medicine,Khyber Teaching Hospital,Peshawar 00000,Pakistan [3]Department of Critical Care Medicine,Mayo Clinic Health System,Mankato,MN 56001,United States [4]Department of Anesthesiology&Critical Care,Houston Methodist Hospital,Houston,TX 77030,United States [5]Department of Medicine,Texas A&M University,College Station,TX 77843,United States [6]Department of Medicine,Aga Khan University,Nairobi,Kenya

出　　处：《World Journal of Clinical Cases》2023年第8期1702-1711,共10页世界临床病例杂志

摘　　要：Thrombolytic therapy has been the mainstay for patients with pulmonary embolism(PE).Despite being linked to a higher risk of significant bleeding,clinical trials demonstrate that thrombolytic therapy should be used in patients with moderate to high-risk PE,in addition to hemodynamic instability symptoms.This prevents the progression of right heart failure and impending hemodynamic collapse.Diagnosing PE can be challenging due to the variety of presentations;therefore,guidelines and scoring systems have been established to guide physicians to correctly identify and manage the condition.Traditionally,systemic thrombolysis has been utilized to lyse the emboli in PE.However,newer techniques for thrombolysis have been developed,such as endovascular ultrasound-assisted catheter-directed thrombolysis for massive and intermediatehigh submassive risk groups.Additional newer techniques explored are the use of extracorporeal membrane oxygenation,direct aspiration,or fragmentation with aspiration.Because of the constantly changing therapeutic options and the scarcity of randomized controlled trials,choosing the best course of treatment for a given patient may be difficult.To help,the Pulmonary Embolism Reaction Team is a multidisciplinary,rapid response team that has been developed and is used at many institutions.Hence to bridge the knowledge gap,our review highlights various indications of thrombolysis in addition to the recent advances and management guidelines.

关 键 词：Pulmonary embolism THROMBOLYTICS SYSTEMIC Catheter-directed Pulmonary embolism reaction team Guidelines 

分 类 号：R563.5[医药卫生—呼吸系统]