急性肺栓塞溶栓治疗.docVIP

Thrombolytics for Acute Pulmonary Embolism from the?ACCP Guidelines, 9th Ed. The ACCP’s recommendation classification system: 1 = “recommendation” 2 = “suggestion” A = based on strong evidence from randomized trials B = moderate evidence that may include randomized trials or observational studies C = weak evidence, mostly consensus opinion Which patients with acute pulmonary embolism should I treat with systemic thrombolytics? The ACCP suggests using systemic thrombolytics to treat patients with acute PE who are hypotensive (they propose a cutoff of systolic blood pressure less than 90 mm Hg). (Grade 2C). ACCP recommends?against?treating most patients with acute PE without hypotension with systemic thrombolytics (Grade 1C). However, patients deemed to be at?high risk?for becoming hypotensive according to clinical course are suggested to receive systemic thrombolytics, if they have a low bleeding risk (Grade 2C). “Looking sick,” dyspneic and hypoxic, right ventricular dysfunction on echocardiogram, elevated troponins, elevated neck veins, severe tachycardia have all been proposed as risk factors. How should I treat acute pulmonary embolism with systemic thrombolytics? A short infusion time of 2 hours for systemic thrombolytics is suggested, rather than a longer infusion (Grade 2C).?Tissue plasminogen activator (tPA) has a short infusion time and has been recommended as the best agent for this reason. Infuse systemic thrombolytics through a peripheral vein, rather than a pulmonary artery catheter (Grade 2C). Randomized trials show that thrombolytics improve pulmonary artery pressures, oxygenation, and cardiac performance on echocardiography within 24 hours in people with acute pulmomary embolism. However, this comes at a significantly higher risk of bleeding compared to other therapies. 13 randomized trials and their meta-analyses suggest that thrombolytic therapy may reduce mortality and recurrent pulmonary embolus, but reviewers share a high suspicion for publicatio