Roham Zamanian

Publication Details

  • Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism CURRENT OPINION IN PULMONARY MEDICINE Zamanian, R. T., Gould, M. K. 2008; 14 (5): 422-426


    Acute pulmonary embolism is a common, life-threatening, cardiopulmonary disorder with a high mortality rate within the first 3 months of diagnosis. As prompt anticoagulation is the mainstay of therapy in patients with pulmonary embolism, the clinical utility and cost effectiveness of systemic thrombolysis is debated.Pulmonary embolism with cardiogenic shock and hypotension is characterized as 'massive' in nature and an accepted indication for thrombolysis, although catheter-directed embolectomy with or without local lytic therapy is preferred in centers with appropriate experience. Acute right ventricular dysfunction is a poor prognostic indicator in patients with pulmonary embolism. The most recent randomized controlled trial of systemic thrombolysis in patients with submassive pulmonary embolism and right ventricular dysfunction found that, compared with heparin alone, alteplase and heparin reduced the risk of clinical deterioration requiring treatment escalation, but did not reduce the risk of death. Subsequently, a formal cost effectiveness concluded that alteplase and heparin was slightly less effective and marginally more expensive than heparin alone in this patient population.Current evidence does not support the use of thrombolytic agents in most hemodynamically stable patients with right ventricular dysfunction. However, improved methods of risk stratification may help to identify subgroups of patients at high risk of death that might benefit from systemic thrombolysis.

    View details for Web of Science ID 000258982100010

    View details for PubMedID 18664972

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