Thrombolysis in embolism pulmonary risk. About 10 cases

Abstract

THROMBOLYSIS IN HIGH RISK PULMONARY
EMBOLISM : ABOUT 10 CASES
Thrombolysis is an essential treatment in pulmonary
embolism with a high risk of premature death in our region
where embolectomy is not developed. We conducted a
retrospective study in a cardiology setting in order to
evaluate the practice. Thus, the folders of 10 patients were
collected. They had a mean age of 41.2 years (22 to 69
years) with a female predominance (sex ratio
0.42). Clinically, dyspnea was a constant finding, acute
circulatory failure was noted in 9 out of 10 cases and 4 of
these patients were in cardiovascular shock. Tachycardia
was found in 9 patients. The average respiratory rate was 41
breaths per minute. Right sided gallop rhythm and raised
jugular venous pressure were found respectively in 3 and 4
cases, and lung consolidation syndrome in 2 cases. The
average Wells score was 6.3. On electrocardiogram, an
S1Q3T3 pattern, a complete right bundle branch block and
antero-septal sub-epicardial ischemia were respectively
found in 3 cases. Doppler echocardiography noted right
ventricular dilatation with an average diameter of 39.1 mm
(34-51 mm) in parasternal long axis view. The septal
curvature was always abnormal of types II or III. Right
ventricular function was impaired in 6 cases. The average
pulmonary artery pressure was 57 mmHg (47-71 mmHg).
Confirmation of pulmonary embolism was made by CT
angiography scan in 6 patients. From the therapeutic point
of view, streptokinase was the only fibrinolytic agent used.
It was used at a dose of 1.5 million international units, over
a period of 2 hours in 9 cases and 12 hours in one
case. Hemorrhagic complications were seen in three cases
among which was one case of profuse vaginal bleeding with
cardiovascular collapse, severe anemia with hemoglobin
concentration of 5.4 g/dl requiring blood transfusion.
Hemodynamic improvement was noted in 6 cases, death
occurred in 4 cases.