S. I. Parkhomenko, K. B. Lapshin, T. Glebovskaya, K. Malikov, N. Marukyan, D. D. Zubarev, D. Alekseeva, O. Moiseeva, M. Simakova
{"title":"肺栓塞:中高危人群介入治疗的选择","authors":"S. I. Parkhomenko, K. B. Lapshin, T. Glebovskaya, K. Malikov, N. Marukyan, D. D. Zubarev, D. Alekseeva, O. Moiseeva, M. Simakova","doi":"10.18705/1607-419x-2023-29-3-306-319","DOIUrl":null,"url":null,"abstract":"Selective transcatheter thrombolysis (STT) in patients with pulmonary embolism (PE) with an intermediatehigh risk of 30-day mortality is an option for rapid lung reperfusion with a decrease in right ventricular (RV) afterload, which largely determines the prognosis of patients.Objective. Comparison of the efficacy of STT using reduced doses of alteplase and routine conservative treatment of patients with PE with an intermediate-high risk of 30-day mortality using a retrospective analysis of the data from Almazov National Medical Research Centre.Design and methods. The retrospective single-center study included 45 patients (18 men (40 %) and 27 women (60 %)) admitted to the anaesthesiology and resuscitation department of the Almazov National Medical Research Centre from January 1, 2021 to May 1, 2022 with the confirmed diagnosis of acute PE. Intermediate-high risk patients (22 people (57,9 %)) were divided into two groups according to the treatment strategy: the group receiving standard anticoagulant therapy (n = 15 (68,2 %)) and the group with STT by alteplase at a total dose of 50 mg (n = 7 (31,8 %)). In order to assess the effectiveness of treatment, the main laboratory and instrumental indicators were compared based on data from the medical information system.Results. Baseline clinical characteristics of the compared groups did not differ. Systolic pressure in the pulmonary artery (SPPA) in the transcatheter treatment group decreased from 59 [50; 82] to 35 [30; 65] mmHg; in the conservative treatment group: from 65 [50; 70] to 52 [40; 59] mmHg. In the selective thrombolysis group, there was a significant trend for a greater decrease SPPA compared to the anticoagulant therapy group: –25 [–29; –3] versus — 10 [–23; –6] mmHg, р = 0,047. There was a significant change in the level of leukocytes and platelets in the group of transcatheter treatment versus anticoagulant therapy: –5,0 [6,1; 4,1] × 109/l vs –2,8 [4,3; 1,8] × 109/l (p = 0,017) and 130 [32; 181] × 1012/l vs 31 [2; 56] × 1012/l (р = 0,044). There were no significant differences in the change in the RV size between the groups. The groups did not differ in the total number of hemorrhagic complications. When bleeding was divided by severity (according to the TIMI classification), moderate bleeding was more common in the selective thrombolysis group (2 cases versus 0 with a conservative approach, p = 0,014). There were no differences in the duration of treatment in the anaesthesiology and resuscitation department and the terms of inpatient treatment.Conclusions. A single center retrospective study demonstrated the high quality of approaches to the diagnosis and treatment of PE in terms of current guidelines. The STT with reduced doses of alteplase was associated with a more significant decrease SPPA and normalization of hemogram parameters when compared to the standard treatment approach. At the same time, selective thrombolysis was associated with a higher risk of hemorrhagic complications. A prospective study of the efficacy and safety of prolonged STT with the selection of the dose of thrombolytic in patients with PE with an intermediate-high risk of 30-day mortality is needed.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"148 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pulmonary embolism: options for interventional treatment in the intermediate-high risk group\",\"authors\":\"S. I. Parkhomenko, K. B. Lapshin, T. Glebovskaya, K. Malikov, N. Marukyan, D. D. Zubarev, D. Alekseeva, O. Moiseeva, M. Simakova\",\"doi\":\"10.18705/1607-419x-2023-29-3-306-319\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Selective transcatheter thrombolysis (STT) in patients with pulmonary embolism (PE) with an intermediatehigh risk of 30-day mortality is an option for rapid lung reperfusion with a decrease in right ventricular (RV) afterload, which largely determines the prognosis of patients.Objective. Comparison of the efficacy of STT using reduced doses of alteplase and routine conservative treatment of patients with PE with an intermediate-high risk of 30-day mortality using a retrospective analysis of the data from Almazov National Medical Research Centre.Design and methods. The retrospective single-center study included 45 patients (18 men (40 %) and 27 women (60 %)) admitted to the anaesthesiology and resuscitation department of the Almazov National Medical Research Centre from January 1, 2021 to May 1, 2022 with the confirmed diagnosis of acute PE. Intermediate-high risk patients (22 people (57,9 %)) were divided into two groups according to the treatment strategy: the group receiving standard anticoagulant therapy (n = 15 (68,2 %)) and the group with STT by alteplase at a total dose of 50 mg (n = 7 (31,8 %)). In order to assess the effectiveness of treatment, the main laboratory and instrumental indicators were compared based on data from the medical information system.Results. Baseline clinical characteristics of the compared groups did not differ. Systolic pressure in the pulmonary artery (SPPA) in the transcatheter treatment group decreased from 59 [50; 82] to 35 [30; 65] mmHg; in the conservative treatment group: from 65 [50; 70] to 52 [40; 59] mmHg. In the selective thrombolysis group, there was a significant trend for a greater decrease SPPA compared to the anticoagulant therapy group: –25 [–29; –3] versus — 10 [–23; –6] mmHg, р = 0,047. There was a significant change in the level of leukocytes and platelets in the group of transcatheter treatment versus anticoagulant therapy: –5,0 [6,1; 4,1] × 109/l vs –2,8 [4,3; 1,8] × 109/l (p = 0,017) and 130 [32; 181] × 1012/l vs 31 [2; 56] × 1012/l (р = 0,044). There were no significant differences in the change in the RV size between the groups. The groups did not differ in the total number of hemorrhagic complications. When bleeding was divided by severity (according to the TIMI classification), moderate bleeding was more common in the selective thrombolysis group (2 cases versus 0 with a conservative approach, p = 0,014). There were no differences in the duration of treatment in the anaesthesiology and resuscitation department and the terms of inpatient treatment.Conclusions. A single center retrospective study demonstrated the high quality of approaches to the diagnosis and treatment of PE in terms of current guidelines. The STT with reduced doses of alteplase was associated with a more significant decrease SPPA and normalization of hemogram parameters when compared to the standard treatment approach. At the same time, selective thrombolysis was associated with a higher risk of hemorrhagic complications. A prospective study of the efficacy and safety of prolonged STT with the selection of the dose of thrombolytic in patients with PE with an intermediate-high risk of 30-day mortality is needed.\",\"PeriodicalId\":37695,\"journal\":{\"name\":\"Arterial Hypertension (Russian Federation)\",\"volume\":\"148 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-03-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arterial Hypertension (Russian Federation)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.18705/1607-419x-2023-29-3-306-319\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arterial Hypertension (Russian Federation)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.18705/1607-419x-2023-29-3-306-319","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Pulmonary embolism: options for interventional treatment in the intermediate-high risk group
Selective transcatheter thrombolysis (STT) in patients with pulmonary embolism (PE) with an intermediatehigh risk of 30-day mortality is an option for rapid lung reperfusion with a decrease in right ventricular (RV) afterload, which largely determines the prognosis of patients.Objective. Comparison of the efficacy of STT using reduced doses of alteplase and routine conservative treatment of patients with PE with an intermediate-high risk of 30-day mortality using a retrospective analysis of the data from Almazov National Medical Research Centre.Design and methods. The retrospective single-center study included 45 patients (18 men (40 %) and 27 women (60 %)) admitted to the anaesthesiology and resuscitation department of the Almazov National Medical Research Centre from January 1, 2021 to May 1, 2022 with the confirmed diagnosis of acute PE. Intermediate-high risk patients (22 people (57,9 %)) were divided into two groups according to the treatment strategy: the group receiving standard anticoagulant therapy (n = 15 (68,2 %)) and the group with STT by alteplase at a total dose of 50 mg (n = 7 (31,8 %)). In order to assess the effectiveness of treatment, the main laboratory and instrumental indicators were compared based on data from the medical information system.Results. Baseline clinical characteristics of the compared groups did not differ. Systolic pressure in the pulmonary artery (SPPA) in the transcatheter treatment group decreased from 59 [50; 82] to 35 [30; 65] mmHg; in the conservative treatment group: from 65 [50; 70] to 52 [40; 59] mmHg. In the selective thrombolysis group, there was a significant trend for a greater decrease SPPA compared to the anticoagulant therapy group: –25 [–29; –3] versus — 10 [–23; –6] mmHg, р = 0,047. There was a significant change in the level of leukocytes and platelets in the group of transcatheter treatment versus anticoagulant therapy: –5,0 [6,1; 4,1] × 109/l vs –2,8 [4,3; 1,8] × 109/l (p = 0,017) and 130 [32; 181] × 1012/l vs 31 [2; 56] × 1012/l (р = 0,044). There were no significant differences in the change in the RV size between the groups. The groups did not differ in the total number of hemorrhagic complications. When bleeding was divided by severity (according to the TIMI classification), moderate bleeding was more common in the selective thrombolysis group (2 cases versus 0 with a conservative approach, p = 0,014). There were no differences in the duration of treatment in the anaesthesiology and resuscitation department and the terms of inpatient treatment.Conclusions. A single center retrospective study demonstrated the high quality of approaches to the diagnosis and treatment of PE in terms of current guidelines. The STT with reduced doses of alteplase was associated with a more significant decrease SPPA and normalization of hemogram parameters when compared to the standard treatment approach. At the same time, selective thrombolysis was associated with a higher risk of hemorrhagic complications. A prospective study of the efficacy and safety of prolonged STT with the selection of the dose of thrombolytic in patients with PE with an intermediate-high risk of 30-day mortality is needed.
期刊介绍:
The main aims of the Journal include collecting and generalizing the knowledge in hypertensiology; education and professional development of cardiologists and medical doctors of other specialties, who deal with different issues regarding diagnostics, management and prevention of hypertension in both clinical practice and research. The Journal also calls attention to the most urgent and up-to-date questions in hypertensiology, cardiology and related sciences. There are additional objectives, such as increasing the availability, accessibility and recognition of Russian medical scientific achievements at the international level by improving the quality of the publication and the way they are presented; enabling the exchange of opinions and information between scientists and their wider communication. The main criteria for publication selection fit with the mentioned objectives and include currency, singularity, scientific and practical novelty, applied relevance etc.