Pulmonary Embolism

Question 1

alteplase dosing and pulmonary embolism

Answer 1

1. Full dose equals 100 mg over 2 hours and patient’s greater than 50 kg weight
2. Half dose equals 0.5 mg/kg over 2 hours
3. The peri-coding patient equals 20 mg bolus then 80 mg over 2 hours
4. Catheter directed thrombolytic lysis: Generally 0.5-1 mg per hour through each catheter

Question 2

heparin infusion during thrombolysis

Answer 2

1. stop immediately before
2. Check PTT immediately after thrombolyzed this and start heparin drip without bolus once PTT is less than 2 times upper limit of normal
3. During catheter directed therapy continue heparin infusion at 500-1000 units per hour

Question 3

MOPETT Trial TPA dosing

Answer 3

dose of tPA was ≤50 percent of the standard dose (100 mg) for patients weighing 50 kg or more and 0.5 mg/kg for those weighing less than 50 kg

Question 4

MOPETT trial results

Answer 4

Lower rates of pulmonary hypertension (by echocardiography; 57 versus 16 percent)

• Lower pulmonary artery systolic pressures (43±6 versus 28±7 mmHg)
• Faster resolution of pulmonary hypertension (50±6 mmHg versus 51±7 mmHg on admission; 43±6 mmHg versus 28±7 mmHg at 28 months)
• Similar rates of bleeding (0 percent in each group)
• Statistically nonsignificant lower rates of recurrent PE (0 versus 5 percent), and mortality (1.6 versus 5 percent)

Question 5

2016 ACCP Guidelines for thrombolysis in acute PE-evidence grade for use in patients with hypotension

Answer 5

21. In patients with acute PE associated with hypotension (eg, systolic BP <90 mm Hg) who do not have a high bleeding risk, we suggest systemically administered thrombolytic therapy over no such therapy (Grade 2B).

Question 6

2016 ACCP Guidelines for thrombolysis in acute PE-evidence grade for use in patients who deteriorate but were not hypotensive

Answer 6

∗23. In selected patients with acute PE who deteriorate after starting anticoagulant therapy but have yet to develop hypotension and who have a low bleeding risk, we suggest systemically administered thrombolytic therapy over no such therapy (Grade 2C).

Question 7

2016 a ACCP guidelinesfor acute PE-evidence based recommendations for use of catheter directed thrombolysis

Answer 7

24. In patients with acute PE who are treated with a thrombolytic agent, we suggest systemic thrombolytic therapy using a peripheral vein over CDT (Grade 2C).
25. In patients with acute PE associated with hypotension and who have (i) a high bleeding risk, (ii) failed systemic thrombolysis, or (iii) shock that is likely to cause death before systemic thrombolysis can take effect (eg, within hours), if appropriate expertise and resources are available, we suggest catheter-assisted thrombus removal over no such intervention (Grade 2C).