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Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline

Thrombolytic therapy has been the mainstay for patients with pulmonary embolism (PE). Despite being linked to a higher risk of significant bleeding, clinical trials demonstrate that thrombolytic therapy should be used in patients with moderate to high-risk PE, in addition to hemodynamic instability...

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Autores principales: Ochani, Rohan Kumar, Aibani, Rafi, Jatoi, Hafsa Nazir, Anwar, Masroor, Khan, Syed Anjum, Ratnani, Iqbal, Surani, Salim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037295/
https://www.ncbi.nlm.nih.gov/pubmed/36970000
http://dx.doi.org/10.12998/wjcc.v11.i8.1702
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author Ochani, Rohan Kumar
Aibani, Rafi
Jatoi, Hafsa Nazir
Anwar, Masroor
Khan, Syed Anjum
Ratnani, Iqbal
Surani, Salim
author_facet Ochani, Rohan Kumar
Aibani, Rafi
Jatoi, Hafsa Nazir
Anwar, Masroor
Khan, Syed Anjum
Ratnani, Iqbal
Surani, Salim
author_sort Ochani, Rohan Kumar
collection PubMed
description Thrombolytic therapy has been the mainstay for patients with pulmonary embolism (PE). Despite being linked to a higher risk of significant bleeding, clinical trials demonstrate that thrombolytic therapy should be used in patients with moderate to high-risk PE, in addition to hemodynamic instability symptoms. This prevents the progression of right heart failure and impending hemodynamic collapse. Diagnosing PE can be challenging due to the variety of presentations; therefore, guidelines and scoring systems have been established to guide physicians to correctly identify and manage the condition. Traditionally, systemic thrombolysis has been utilized to lyse the emboli in PE. However, newer techniques for thrombolysis have been developed, such as endovascular ultrasound-assisted catheter-directed thrombolysis for massive and intermediate-high submassive risk groups. Additional newer techniques explored are the use of extracorporeal membrane oxygenation, direct aspiration, or fragmentation with aspiration. Because of the constantly changing therapeutic options and the scarcity of randomized controlled trials, choosing the best course of treatment for a given patient may be difficult. To help, the Pulmonary Embolism Reaction Team is a multidisciplinary, rapid response team that has been developed and is used at many institutions. Hence to bridge the knowledge gap, our review highlights various indications of thrombolysis in addition to the recent advances and management guidelines
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spelling pubmed-100372952023-03-25 Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline Ochani, Rohan Kumar Aibani, Rafi Jatoi, Hafsa Nazir Anwar, Masroor Khan, Syed Anjum Ratnani, Iqbal Surani, Salim World J Clin Cases Minireviews Thrombolytic therapy has been the mainstay for patients with pulmonary embolism (PE). Despite being linked to a higher risk of significant bleeding, clinical trials demonstrate that thrombolytic therapy should be used in patients with moderate to high-risk PE, in addition to hemodynamic instability symptoms. This prevents the progression of right heart failure and impending hemodynamic collapse. Diagnosing PE can be challenging due to the variety of presentations; therefore, guidelines and scoring systems have been established to guide physicians to correctly identify and manage the condition. Traditionally, systemic thrombolysis has been utilized to lyse the emboli in PE. However, newer techniques for thrombolysis have been developed, such as endovascular ultrasound-assisted catheter-directed thrombolysis for massive and intermediate-high submassive risk groups. Additional newer techniques explored are the use of extracorporeal membrane oxygenation, direct aspiration, or fragmentation with aspiration. Because of the constantly changing therapeutic options and the scarcity of randomized controlled trials, choosing the best course of treatment for a given patient may be difficult. To help, the Pulmonary Embolism Reaction Team is a multidisciplinary, rapid response team that has been developed and is used at many institutions. Hence to bridge the knowledge gap, our review highlights various indications of thrombolysis in addition to the recent advances and management guidelines Baishideng Publishing Group Inc 2023-03-16 2023-03-16 /pmc/articles/PMC10037295/ /pubmed/36970000 http://dx.doi.org/10.12998/wjcc.v11.i8.1702 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Minireviews
Ochani, Rohan Kumar
Aibani, Rafi
Jatoi, Hafsa Nazir
Anwar, Masroor
Khan, Syed Anjum
Ratnani, Iqbal
Surani, Salim
Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline
title Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline
title_full Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline
title_fullStr Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline
title_full_unstemmed Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline
title_short Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline
title_sort evolving paradigm of thrombolysis in pulmonary embolism: comprehensive review of clinical manifestations, indications, recent advances and guideline
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037295/
https://www.ncbi.nlm.nih.gov/pubmed/36970000
http://dx.doi.org/10.12998/wjcc.v11.i8.1702
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