Fibrinolytic regimen evaluation
Variable
Pre n = 40 (%)
Post n = 40 (%)
p
Right ventricular sound
96
5
<0.0001
Shock
15
0
<0.0001
Respiratory rate
33.5 ± 5.7
25.0 ± 4.4
<0.0001
Cardiac rate
108.9 ± 13.1
94.4 ± 8.9
0.008
Systolic pressure
102.3 ± 19.7
119.5 ± 10
<0.001
Diastolic pressure
61.2 19.6
76.7 ± 8.4
<0.001
Oximetry
84.7 ± 4.3
95.5 ± 3.1
<0.001
Echocardiogram
PA systolic pressure
62.3 ± 12.4
38.26 ± 12.4
<0.001
RV diastolic diameter
43.9 ± 4.4
32.30 ± 4.8
<0.001
RV hypokinesis
75
18
0.007
McConnell sign
48
8
0.005
V/Q lung scan (32 patients)
Perfusion defects
10.7 ± 1.7
6.07 ± 3.1
<0.001
Unfractionated heparin evaluation
Variable
Pre
Post
p
Right ventricular sound
95
95
1
Shock
18
18
1
Respiratory rate
37.5 ± 3.4
38.0 ± 5.6
0.63
Cardiac rate
116.0 ± 10.2
111.0 ± 9.1
0.02
Systolic pressure
103.5 ± 18.5
95 ± 20.4
0.05
Oximetry
83.5 ± 3.6
81.7 ± 5.8
0.06
Echocardiogram
PA systolic pressure
58.4 ± 1.8
56.2 ± 3.6
0.0009
RV diastolic diameter
41.0 ± 2.9
44.0 ± 4.9
0.001
RV hypokinesis
90
90
1
McConnell sign
43
40
95
V/Q lung scan (32 patients)
Perfusion defects
10.5 ± 1.8
7.0 ± 2.84
0.001
In-hospital clinical course and adverse events: Findings regarding major adverse cardiovascular events, escalation treatment, in-hospital stay, and bleeding complications are presented in Table 5.2. Patients under thrombolysis had better outcome than patients under unfractionated heparin alone. Major bleeding complications had a close relationship with venous puncture in both groups [10].
Table 5.2
In-hospital outcome, follow-up, and adverse events
Variable | Alteplase 1 h + enoxaparin n = 40 (%) | UH n = 40 (%) | p |
---|---|---|---|
Mortality | 3 | 25 | 0.009 |
Recurrence | 10 | 20 | 0.17 |
Escalation treatment | 3 | 53 | <0.001 |
In-hospital stay (days) | 6.7 ± 1.7 | 16.4 ± 8.7 | <0.001 |
Rescue thrombolysis | 10 | 0 | 0.12 |
Bleeding (total) | 13 | 13 | 1 |
Major hemorrhage | 8 | 8 | 1 |
Groin hematoma | 5 | 3 | 0.78 |
Jugular hematoma | 3 | 5 | 0.78 |
Intracranial hematoma | 0 | 0 | – |
Minor hemorrhage | 5 | 5 | 1 |
Cava filter | 3 | 43 | <0.001 |
Pulmonary percutaneous intervention | 5 | 0 | 0.47 |
Follow-up and adverse events | |||
30 days | |||
Patients | 39 | 30 | |
Mortality | 0 | 3 | 0.89 |
Recurrence PE | 0 | 3 | 0.06 |
DVT | 0 | 7 | 0.36 |
Bleeding | 0 | 0 | – |
Perfusion defects | 3.4 ± 2.0 | 5.2 ± 1.6 | <0.001 |
Normal echocardiogram | 90 | 87 | 0.98 |
90 days | |||
Patients | 39 | 29 | |
Mortality | 0 | 7 | 0.34 |
Recurrence PE | 3 | 7 | 0.79 |
DVT | 0 | 7 | 0.34 |
Bleeding | 0 | 0 | – |
Perfusion defects | 2.8 ± 2.1 | 4.6 ± 1.5 | <0.001 |
Normal echocardiogram | 95 | 82 | 0.22 |
180 days | |||
Patients | 39 | 27 | |
Mortality | 0 | 7 | 0.34 |
Recurrence PE | 0 | 22 | 0.007 |
DVT | 0 | 26 | 0.003 |
Bleeding | 0 | 0 | – |
Normal echocardiogram | 97 | 55 | 0.01 |
Patients | 40 | 40 | |
Global mortality | 3 | 38 | 0.0002 |
Follow-up and major adverse cardiovascular events: Follow-up was complete in 100 % of the cases (Table 5.2). Within the first 30 and 90 days the most important clinical finding was a pulmonary perfusion improvement in alteplase plus enoxaparin group compared with unfractionated heparin alone. Although a trend to major incidence of major adverse cardiovascular events in unfractionated heparin group was observed, these clinical findings had statistical significance until day 180, including a better right ventricular remodeling. Global mortality was another relevant clinical finding (Table 5.2) [10].