Medical compared with surgical treatment for massive pulmonary embolism

Item Type:	Article
Title:	Medical compared with surgical treatment for massive pulmonary embolism
Creators Name:	Gulba, D. and Schmid, C. and Borst, H.G. and Lichtlen, P.R. and Dietz, R. and Luft, F.C.
Abstract:	We compared embolectomy (when available) with thrombolysis in patients with shock and massive pulmonary embolism. 13 patients were operated on, 10 (77%) of whom survived. The inferior vena cava was routinely clipped. The 24 medically treated patients were given alteplase until systemic and pulmonary artery pressures stabilised and heparin thereafter; 16 (67%) survived. Major haemorrhage occurred in 28% of medically treated patients, but was not fatal. 1 patient had a small cerebral haemorrhage that resolved without drainage. One-fifth of the medical group had a re-embolism, which suggests that temporary caval umbrellas are indicated in medically treated patients. Thrombolysis may provide a life-saving option and a randomised trial is warranted.
Keywords:	Combination Drug Therapy, Follow-Up Studies, Hemorrhage, Heparin, Inferior Vena Cava, Pulmonary Artery, Pulmonary Embolism, Thrombolytic Therapy, Tissue Plasminogen Activator, Treatment Outcome
Source:	Lancet
ISSN:	0140-6736
Publisher:	Lancet
Volume:	343
Number:	8897
Page Range:	576-577
Date:	5 March 1994
Official Publication:	https://doi.org/10.1016/S0140-6736(94)91523-7
PubMed:	View item in PubMed

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