Massive Pulmonary Embolism: Optimizing Collaborative Care and Endovascular Therapy.
Massive Pulmonary Embolism: Optimizing Collaborative Care and Endovascular Therapy.
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大规模肺栓塞：优化协作护理和血管内治疗。
DOI：
10.1161/circinterventions.123.013536
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Vedantham,Suresh
中科院分区：
文献类型：
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作者：
Vedantham,Suresh
大面积肺栓塞（PE）患者的管理受益于系统性努力，以确保快速实现治疗性抗凝、重症监护医学的进步以及机械循环支持工具的使用增加。然而，该PE亚群的死亡率较高，促使人们对能够快速溶解血栓、逆转右心功能障碍和稳定患者的治疗持续感兴趣。全身溶栓（ST）是广泛可用的，可以在重症监护室环境中统一提供。随机对照试验（RCT）的荟萃分析表明，与单用抗凝治疗相比，ST治疗的死亡率略有提高，但也增加了大出血和颅内出血。1，2因此，虽然ST被推荐用于大面积PE患者，但其实际使用和临床影响受到对其安全性的担忧的限制。
The management of patients with massive pulmo-nary embolism (PE) has benefited from systematic efforts to ensure rapid achievement of therapeutic anticoagulation, advances in critical care medicine, and increased use of mechanical circulatory support tools. Nevertheless, mortality rates in this PE subpopulation are high, prompting ongoing interest in therapies that enable rapid thrombus dissolution, reversal of right heart dysfunction, and patient stabilization. Systemic thrombolysis (ST) is widely available and can be uniformly delivered in the intensive care unit setting. Meta-analysis of randomized controlled trials (RCTs) suggests the presence of a small mortality benefit with ST, but also increased major bleeding and intracranial bleeding, compared with anticoagulation alone. 1, 2 Hence, while ST is recommended for patients with massive PE, its actual utilization and clinical impact are constrained by concerns about its safety profile.