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The Resus Room

Massive PE Thrombolysis

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8678 Ratings

🗓️ 10 November 2017

⏱️ 26 minutes

🧾️ Download transcript

Summary

If you talk to people about the topic of thrombolysis in PE they'll tell you about the controversy of the submassive category, but there's a universal acceptance that thrombolysing massive PE's is well evidenced and straight forward.

In this episode we delve back into the literature and not only explore massive PE thrombolysis, but also the gold standard to which it is judged upon, heparin.

Have a listen to the podcast and as always we would love to hear your thoughts.

Enjoy!

Simon & Rob

References & Further Reading

Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension. A Scientific Statement From the American Heart Association. 2011

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1438862/pdf/jrsocmed00257-0051.pdfValue of anticoagulants in the treatment of pulmonary embolism: a discussion paper. Paul Egermayer. Journal of the Royal Society of Medicine 1981.

Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. BARRITT DW. Lancet. 1960

Treatment of pulmonary embolism in total hip replacement. Johnson R. Clin Orthop Relat Res. 1977

PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2. Dalla-Volta S. J Am Coll Cardiol. 1992 

Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Goldhaber SZ. Lancet. 1993

Transcript

Click on a timestamp to play from that location

0:00.0

Welcome to the Recess Room podcast.

0:03.9

Five, four, three, two, one, fire.

0:13.5

So hi, and welcome back to the Recess Room podcast. I'm Simon Lang, and I'm Rob Fenwick.

0:19.0

And this is a podcast that I've been looking forward to doing for a long, long time

0:23.3

So this is on the topic of massive PEs and thrombolysis

0:28.6

Oh clear cut then, no problems, we'll have it wrapped up in five minutes

0:32.3

So there is a lot of chitter chatter in foam about thromolising submassive pees, and everyone seems to be of the opinion that massive P.E. thrombolysis is pretty much a given. But there's some pretty interesting evidence base and guidelines that actually underpins this. I thought it might be worth unpicking this before we go on to another podcast where we'll

0:54.4

have a look at the submassive thrombolysis itself.

0:57.9

Sounds like a great plan.

0:59.0

I'm happy to roll with that.

1:00.2

Before we get on with it, a huge thanks to Abrak for sponsoring the podcast.

1:05.0

Right on with the topic.

1:09.5

Right, so I think we're all pretty aware that P.E.s are not actually a good thing.

1:16.3

Certainly the big ones.

1:17.7

Certainly the big ones.

1:18.9

Yeah, I'd agree with you on that.

1:20.9

Good.

1:21.3

Glad we're starting on the same sheet.

1:22.8

So, P.E. is a major cause of morbidity and mortality.

1:27.2

And, I mean, it is really difficult to come up with

1:31.0

epidemiological values of how prevalent this disease is, because we are picking up more and more

1:37.7

PEs as we investigate them. As our CT scanners get better and they're more sensitive, we're finding

...

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