Transfemoral Catheter Thrombolysis and Use of Sildenafil in Acute Massive Pulmonary Embolism

Abstract

ACUTE PULMONARY EMBOLISM (PE) develops in approximately 630,000 people annually and contributes to 200,000 deaths annually. 1 Dalen J.E. Alpert J.S. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975; 17: 259-270 Abstract Full Text PDF PubMed Scopus (955) Google Scholar The prophylactic use of heparin, vitamin K antagonists, or compression stockings are standard care in hospitalized individuals and particularly important in surgical patients because they have an increased risk for deep venous thrombosis and pulmonary embolism. The mortality associated with massive PE is secondary to acute right-heart failure and circulatory shock. 2 Lualdi J.C. Goldhaber S.Z. Right ventricular dysfunction after acute pulmonary embolism: Pathophysiologic factors, detection, and therapeutic implications. Am Heart J. 1995; 130: 1276-1282 Abstract Full Text PDF PubMed Scopus (263) Google Scholar Estimated mortality in the post-thrombolytic era in patients with acute PE with hemodynamic instability is between 23% and 38% 3 Arcasoy S.M. Kreit J.W. Thrombolytic therapy of pulmonary embolism: A comprehensive review of current evidence. Chest. 1999; 115: 1695-1707 Crossref PubMed Scopus (218) Google Scholar , 4 Dalen J.E. Alpert J.S. Hirsh J. Thrombolytic therapy for pulmonary embolism: Is it effective? Is it safe? When is it indicated?. Arch Intern Med. 1997; 157: 2550-2556 Crossref PubMed Google Scholar ; approximately 90% of these deaths occur within 2 hours of the onset of symptoms. 5 Soloff L.A. Rodman T. Acute pulmonary embolism II. Clinical. Am Heart J. 1967; 74: 829-847 Abstract Full Text PDF PubMed Scopus (70) Google Scholar , 6 Soloff L.A. Rodman T. Acute pulmonary embolism I. Review. Am Heart J. 1967; 74: 710-724 Abstract Full Text PDF PubMed Scopus (32) Google Scholar , 7 Stein P.D. Henry J.W. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest. 1995; 108: 978-981 Crossref PubMed Scopus (609) Google Scholar , 8 Tapson V.F. Witty L.A. Massive pulmonary embolism Diagnostic and therapeutic strategies. Clin Chest Med. 1995; 16: 329-340 PubMed Google Scholar Acute right-heart failure together with poor filling of the left heart are indicative; this condition may rapidly lead to circulatory arrest. 2 Lualdi J.C. Goldhaber S.Z. Right ventricular dysfunction after acute pulmonary embolism: Pathophysiologic factors, detection, and therapeutic implications. Am Heart J. 1995; 130: 1276-1282 Abstract Full Text PDF PubMed Scopus (263) Google Scholar