DOI: http://dx.doi.org/10.18203/2349-3933.ijam20161908

Impact of tenecteplase in intermediate and high risk pulmonary embolism

S. Thrudeep, T. G. Jayakumar, G. Rajesh, G. Rupesh, K.G. Geofi, S. Gagan, S. Abdulkhadar

Abstract


Background: Pulmonary embolism (PE) is a 3rd most common lethal cardiovascular disease. The objective was to study the outcome of high and intermediate risk acute pulmonary embolism (PE) with special reference to Tenecteplase.

Methods: Retrospective observational study of clinical features and outcome of high and intermediate risk patients with acute pulmonary embolism treated with Tenecteplase from January 2008 to January 2016.

Results: 40 patients who were newly diagnosed to have PE with a mean age of 54 years were included in the study. Dyspnea and syncope were the predominant symptoms in both IR and HR. Most sensitive parameter i.e. D-dimer was positive among all 40 cases but cardiac biomarker troponin was positive in 56.8% cases only. Evidence of RV dysfunction was present all cases with 65% cases had presented with severe pulmonary arterial hypertension. Diagnosis of acute pulmonary embolism was confirmed by MDCT of lung.  All confirmed cases of acute PE were administered dose adjusted intravenous tenectaplse. Of the 40 patients, 39 were discharged and were under regular follow up for 6 months. In hospital mortality of HR and IR 11% &3.2% respectively but 2 more cases expired within a span of 7 days after discharge due to sepsis and neurological shock. Major bleeding manifestations more in HR as compared to IR group.

Conclusions: Tenectaplase is a potent thrombolytic agent which can be used as the drug of choice for acute PE of usual causes without many complications. Prompt diagnosis and treatment of PE with potent thrombolytics can be life-saving.


Keywords


Acute pulmonary embolism, High risk, Intermediate risk group, Tenecteplase

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References


Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107:22-30.

Thrudeep S. Sharma G, George R, George G, Gopinath R, Jayakumar TG, et al. A rare association of pulmonary thromboembolism in non-obstructive cortriatriatum. Kerala Heart J. 2014:4(1):402.

Molloy WD, Lee KY, Girling L, Schick U, Prewitt RM. Treatment of shock in a canine model of pulmonary embolism. Am Rev Respir Dis. 1984;130(5):870-4.

Mauritz GJ, Marcus JT, Westerhof N, Postmus PE, Noordegraaf VA. Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension is not a reflection of diastolic dysfunction. Heart. 2011;97(6):473-8.

Acute Pulmonary Embolism (Diagnosis and Management of). Available at http:// www.escardio.org/Guidelines-&-Education/ linical-Practice-Guidelines/ Acute-Pulmonary-Embolism-Diagnosis-and-Management-of. Accessed on 15 November 2014.

Anderson FA, Wheeler HB. Venous thromboembolism. Risk factors and prophylaxis. Clin Chest Med. 1995;16:235-51.

Samuel GZ. Risk factors of venous thromboembolism. J Am Coll Cardiol. 2010;56:1-7.

Davidsingh SC, Srinivasan N, Balaji P, Kalaichelvan U, Mullasaric AS. Study of clinical profile and management of patients with pulmonary embolism Single center study. Indian Heart J. 2014;66:97-202.

Stein PD, Terrin ML, Hales CA, Palvesky HI. Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no preexisting cardiac or pulmonary disease. Chest. 1991;100:598-607.

Sinha N, Yalamanchili K, Sukhija R, Aronow WS. Role of 12-lead electrocardiogram in diagnosing pulmonary embolism. Cardiol Rev. 2005;13:46-9.

Bounameaux H, Moerloose P, Perrier A, Reber G. Plasma measurement of D-dimmer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Headmost. 1994;71:1-6.

Hammond CJ, Hassan TB. Screening for pulmonary embolism with a D-dimmer assay: do still need to assess clinical probability. JR Soc Med. 2005;98:54-8.

Egermayer P, Town GI, Turner JG, Heaton DC, Mee AL, Beard ME. Usefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism. Thorax. 1998;53:830-4.

Becattini C, Vedovati MC, Agnelli I. Prognostic value of troponins in acute pulmonary embolism a meta-analysis. Circulation. 2007;116:427-33.

Moser KM, Fedullo PF, LitteJohn JK, Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. J Am Med Asso. 1994;271:223-5.

Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Arch Intern Med. 2002;136:691-700.

Burrowes KS, Clark AR, Tawhai MH. Blood flow redistribution and ventilation perfusion mismatch during embolic pulmonary arterial occlusion. Pulm Circ. 2011;1(3):365-76.

Padley SPG. Lung scintigraphy vs spiral CT in the assessment of pulmonary emboli. Br J Radiol. 2002;75:5-8.

Hartmann IJ, Hagen PJ, Melissant CF, Postmus PE, Prins MH. Diagnosing acute pulmonary embolism: effect of COPD on performance of D-dimer testing, perfusion scintigraphy, spiral CT angiography and conventional angiography. ANTELOPE study group: advances in new technologies evaluating the localization of pulmonary embolism. Am J Respir Crit Care Med. 2000;162(6):2232-7.

Dalla VS, Palla A, Santolicandro A, Giuntini C, Pengo V, Visioli OG, et al. PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2. J Am Coll Cardiol.1992;20(3):520-6.

Becattini C, Agnelli G, Salvi A, Grifoni S, Pancaldi LG, Enea I, et al. Bolus tenecteplase for right ventricle dysfunction in hemodynamically stable patients with pulmonary embolism. Thromb Res. 2010;125(3):82-6.

Meneveau N, Seronde MF, Blonde MC, Legalery P, Didier PK, Briand F, et al. Management of unsuccessful thrombolytic in acute massive pulmonary embolism. Chest. 2006;129(4):1043-50.

Daniels LB, Parker JA, Patel SR, Grodstein F, Goldhaber SZ. Relation of duration of symptoms with response to thrombolytic therapy in pulmonary embolism. Am J Cardiol.1997;80(2):184-8.

Kanter DS, Mikkola KM, Patel SR, Parker JA, Goldhaber SZ. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest.997;111(5):1241-5.

Levine MN, Goldhaber SZ, Gore JM, Hirsh J, Califf RM. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism. Chest. 1995;108(4):291-301.

Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Westendorf JB, PEITHO trial Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370(15):1402-11.

Kline JA , Nordenholz KE, Courtney DM, Kabrhel C, Jones AE, Rondina MT. Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at three months (TOPCOAT): Multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost.2014;12(4):459-68.

Gowrinath K, Reddy GK. CT appearances in patient with pulmonary thromboembolism and infarction. Indian J Chest Dis Allied Sci.2003;45:116-20.

Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):195-226.

Agarwal R, Gulati M, Mittal BR, Jindal SK. Clinical profile, diagnosis and management of patients presenting with symptomatic pulmonary embolism. Indian J Chest Dis Allied Sci. 2006;48:111-5.

Paul SD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest. 1997;112(4):974-9.

Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med. 2012;125(5):465-70.

Bhuvaneswar JS, Premchand RK, Iyengar SS, Rajeev Khare, Chabra CB, Padmanabhan TN, et al. Tenectaplase in the treatment of acute pulmonary thrombo embolism. J Thromb Thrombolysis. 2011;31(4):445-8.

Shukla AN, Thakkar B, Jayaram AA, Madan TH, Gandhi GD. Efficacy and safety of Tenecteplase in acute pulmonary embolism. J Thromb Thrombolysis. 2014;38(1):24-9.