Value of thrombolytic therapy for submassive pulmonary embolism patients

Abstract

Background and aim of the study The aim of this study was to assess the value of streptokinase in patients with submassive pulmonary embolism (PE) due to unavailability of tissue plasminogen activator in our locality due to limited income sources. Patients and methods A prospective randomized controlled trial was conducted on a total number of 52 patients with a confirmed diagnosis of submassive PE confirmed by computed tomographic pulmonary angiography were further investigated by echocardiography and cardiac biomarkers after ethical approval from the IRB and confirmed written consent from the patients or first-degree relative. The study was conducted between January 2017 and December 2017, at the Chest Department, Mansoura University Hospitals, and the Cardiology Department, Specialized Internal Medicine Hospital, Faculty of Medicine, Mansoura University. Results Fifty-two patients who were diagnosed as having submassive PE were enrolled; 24 patients were randomized to the thrombolytic group (TG) and 28 to the anticoagulant group (AG) by simple randomization through opening a closed envelope. The two groups were compared as regards demographic data, pulmonary artery systolic pressure (PASP), presence of comorbidities (diabetes mellitus) and presence of malignancy or concomitant deep venous thrombosis as risk factors, and the incidence of unprovoked PE without any statistically significant results.The PASP measured 72 h after therapy in the TG was improved with statistically significant difference when compared with that measured before starting therapy (P Conclusion Thrombolytic therapy should be considered over anticoagulation as first-line management in submassive PE causing right ventricular dysfunction without hypotension. Clinical implications Early identification of submassive PE and start of thrombolytic therapy after exclusion of bleeding risk in the patient for thrombolysis can improve outcome and decrease hospital stay.