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The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital
Submassive or intermediate-risk pulmonary embolism (PE) occurs when an acute PE episode is associated with radiographic evidence of right heart strain without hemodynamic instability. Further risk stratification is important in determining whether systemic thrombolytic therapy should be administered...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686931/ https://www.ncbi.nlm.nih.gov/pubmed/33251058 http://dx.doi.org/10.7759/cureus.11148 |
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author | Zhang, Qian Vayalumkal, Jonathan Ricely, John Gray, Daniel L Raza, Ahmad |
author_facet | Zhang, Qian Vayalumkal, Jonathan Ricely, John Gray, Daniel L Raza, Ahmad |
author_sort | Zhang, Qian |
collection | PubMed |
description | Submassive or intermediate-risk pulmonary embolism (PE) occurs when an acute PE episode is associated with radiographic evidence of right heart strain without hemodynamic instability. Further risk stratification is important in determining whether systemic thrombolytic therapy should be administered when weighing the risks and benefits. It includes the risk of death from acute PE versus the risk of bleeding. This decision could be further complicated in institutions where there is a lack of complete therapeutic options, which increases the importance of the expertise of a pulmonologist or an intensivist to decide whether rescue reperfusion is needed. We describe the case of a 34-year-old female patient with a history of right thigh abscess and diabetes mellitus who was admitted for diabetic ketoacidosis (DKA) along right thigh abscess status post-incision and drainage. She had a syncopal episode and was found to have submassive PE with right heart strain with stable hemodynamics and oxygen requirement. She tolerated systemic thrombolytic therapy without complications with a drastic improvement in her cardiac function post-treatment. |
format | Online Article Text |
id | pubmed-7686931 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-76869312020-11-27 The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital Zhang, Qian Vayalumkal, Jonathan Ricely, John Gray, Daniel L Raza, Ahmad Cureus Pulmonology Submassive or intermediate-risk pulmonary embolism (PE) occurs when an acute PE episode is associated with radiographic evidence of right heart strain without hemodynamic instability. Further risk stratification is important in determining whether systemic thrombolytic therapy should be administered when weighing the risks and benefits. It includes the risk of death from acute PE versus the risk of bleeding. This decision could be further complicated in institutions where there is a lack of complete therapeutic options, which increases the importance of the expertise of a pulmonologist or an intensivist to decide whether rescue reperfusion is needed. We describe the case of a 34-year-old female patient with a history of right thigh abscess and diabetes mellitus who was admitted for diabetic ketoacidosis (DKA) along right thigh abscess status post-incision and drainage. She had a syncopal episode and was found to have submassive PE with right heart strain with stable hemodynamics and oxygen requirement. She tolerated systemic thrombolytic therapy without complications with a drastic improvement in her cardiac function post-treatment. Cureus 2020-10-25 /pmc/articles/PMC7686931/ /pubmed/33251058 http://dx.doi.org/10.7759/cureus.11148 Text en Copyright © 2020, Zhang et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Pulmonology Zhang, Qian Vayalumkal, Jonathan Ricely, John Gray, Daniel L Raza, Ahmad The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital |
title | The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital |
title_full | The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital |
title_fullStr | The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital |
title_full_unstemmed | The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital |
title_short | The Difficult Clinical Decision of Thrombolytic Therapy for Submassive Pulmonary Embolism in a Community Hospital |
title_sort | difficult clinical decision of thrombolytic therapy for submassive pulmonary embolism in a community hospital |
topic | Pulmonology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686931/ https://www.ncbi.nlm.nih.gov/pubmed/33251058 http://dx.doi.org/10.7759/cureus.11148 |
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