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Acil Serviste t-Pa Uygulanmış Akut Pulmoner Tromboemboli Tanılı Hastaların İncelenmesi

Year 2018, Volume: 1 Issue: 2, 1 - 5, 28.12.2018

Abstract

Amaç: Bu çalımada acil serviste pulmoner tromboemboli nedeniyle t-PA tedavisi alan hastaların demografik özellikleri, komorbid durumları, risk faktörleri, laboratuvar bulguları, görüntüleme sonuçları, risk skorları, tedavi sonrası komplikasyonlar ve sonlanımı deerlendirmeyi amaçladık. Çalımanın ikinci amacı, hem tedavi etkinliinin deerlendirilmesi hem de risk altındaki hasta grubunu belirlemek için hangi parametrelerin kullanılabileceini belirlemekti.

Metod: Bu retrospektif çalımaya PE tanısı almı ve üniversite hastanesinin üçüncü bir acil servisinde trombolitik ajanlarla tedavi edilen bireyler dahil edilmitir. Bavuru sırasındaki ikayetler, demografik veriler, biyokimyasal sonuçlar, radyolojik bulgular, klinik özellikler ve sonuçlar analiz edildi. Hastaların tıbbi kayıtlarından Wells skorları hesaplanmıtır. Ayrıca hastalarda trombolitik tedavi sonrası tercih edilen medikal tedavi, gelien komplikasyonlar ve hastaların sonlanı biçimleri incelendi. Çalımaya dahil edilen hastaların PESI deerleri hesaplanarak prognoz deerlendirilmesi yapılmıtır.

Bulgular: Çalımaya 59 hasta dahil edildi. Hastaların 30’u (%50,8) kadın ve 29’u (%49,2) erkekti. Hastaların ya ortalaması 58,1 (18-84; SS:18) idi. Klinik sınıflandırmaya bakıldıında; 31 (%52,5) hasta yüksek riskli PTE, 28 (%47,5) hasta düük riskli PTE olarak gruplandı. Yüksek ve düük riskli PE hastalar arasında demografik ve klinik veriler açısından istatistiksel olarak anlamlı bir fark yoktu (p> 0.05). Yüksek riskli grupta PESI skoru yüksek saptandı (24 vs 9, p <0.01). Yüksek ve düük riskli gruplar arasındaki sonlanım ve komplikasyon oranı açısından gruplar arasında istatistiksel olarak anlamlı farklılık bulunmadı (p> 0.05).

Sonuç: Bizim görüümüze göre bu çalımadan çıkan en önemli sonuç; yüksek riskli olan PTE grubunda PESI deerlerinin daha yüksek olması dıında, trombolitik tedavi süreci ve sonrası gelien komplikasyonlar açısından her iki grup arasında önemli bir fark saptanmamı olmasıdır.

References

  • Zhang Z, Zhai ZG, Liang LR, Liu FF, Yang YH, Wang C. Lower dosage of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of acute pulmonary embolism: a systematic review and meta-analysis. Thromb Res. 2014 Mar;133(3):357-63.
  • Dirican A, Ozkaya S, Atas AE, Ulu EK, Kitapci I, Ece F. Thrombolytic treatment (alteplase; rt-Pa) in acute massive pulmonary embolism and cardiopulmonary arrest. Drug Des Devel Ther. 2014 Jun 12;8:759-63.
  • Tapson VF. Thrombolitic therapy in acute pulmonary embolism. Curr Opin Cardiol. 2012 Nov;27(6):585-91.
  • Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2008 Sep;29(18):2276-315.
  • Vyas PA, Donato AA. Thrombolysis in Acute Pulmonary Thromboembolism . South Med J. 2012 Oct;105(10):560-70.
  • Lankeit M, Konstantinides S. Thrombolytic therapy for submassive pulmonary. Best Pract Res Clin Haematol. 2012 Sep;25(3):379-89.
  • Curtis GM, Lam SW, Reddy AJ, Bauer SR. Risk Factors Associated with Bleeding After Alteplase Administration for Pulmonary Embolism: A Case-Control Study. Pharmacotherapy. 2014 Aug;34(8):818-25.
  • Bozbay M, Uyarel H, Avsar S, Oz A, Keskin M, Tanik VO et al. Creatinine kinase isoenzyme–MB: A simple prognostic biomarker in patients with pulmonary embolism treated with thrombolytic therapy. J Crit Care. 2015 Dec;30(6):1179-83.
  • Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M. Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial). Am J Cardiol. 2013 Jan 15;111(2):273-7.

Analysis of Patients Received Intravenous t-PA with a Diagnosis of Acute Pulmonary Thromboembolism in Emergency Department

Year 2018, Volume: 1 Issue: 2, 1 - 5, 28.12.2018

Abstract

Aim: In this study we aimed to evaluate the demographic characteristics, comorbid conditions, risk factors, laboratory findings, imaging results, risk scores, post-treatment complications and outcome patterns of patients who received t-PA treatment for pulmonary thromboembolism in emergency department. The second aim of the study was both the evaluation of treatment efficacy and the determination of which parameters could be used to determine the patient group at risk.

Material and Methods: Individuals diagnosed PE and treated with thrombolytic agents in a tertiary emergency department of university hospital were included into this retrospective study. Complaints at admission, demographic data, biochemical results, radiological findings, clinical features and outcome were analyzed. Wells scores were calculated from the medical records of the patients. In addition, the medical treatment, complications and termination methods of the patients after thrombolytic therapy were evaluated. PESI values of patients included in the study were calculated and prognosis was evaluated.

Results: Fifty-nine patients were included to this study. Of 59 patients, 30 (50.8%) were female and 29 (49.2%) were male. Mean age was 58.1 (Range: 18-84; SD: 18). Clinical grading of patient cohort revealed 31 (52.5%) high-risk PE patients and 28 (47.5%) low- risk PE patients. There were no statistically significant differences between high- and low-risk PE patients in terms of demographic and clinical data (p>0.05). PESI score was high in high-risk group (24 vs 9, p <0.01). Rate of complications, and outcome between high- and low-risk groups showed no statistically significant differences (p>0.05).

Conclusion: With the exception of a higher PESI score in high- risk PE group, we determined no expected correlation between pulmonary embolism risk scoring systems and post-treatment complications of pulmonary embolism.

 

 

 

 

References

  • Zhang Z, Zhai ZG, Liang LR, Liu FF, Yang YH, Wang C. Lower dosage of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of acute pulmonary embolism: a systematic review and meta-analysis. Thromb Res. 2014 Mar;133(3):357-63.
  • Dirican A, Ozkaya S, Atas AE, Ulu EK, Kitapci I, Ece F. Thrombolytic treatment (alteplase; rt-Pa) in acute massive pulmonary embolism and cardiopulmonary arrest. Drug Des Devel Ther. 2014 Jun 12;8:759-63.
  • Tapson VF. Thrombolitic therapy in acute pulmonary embolism. Curr Opin Cardiol. 2012 Nov;27(6):585-91.
  • Konstantinides S, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2008 Sep;29(18):2276-315.
  • Vyas PA, Donato AA. Thrombolysis in Acute Pulmonary Thromboembolism . South Med J. 2012 Oct;105(10):560-70.
  • Lankeit M, Konstantinides S. Thrombolytic therapy for submassive pulmonary. Best Pract Res Clin Haematol. 2012 Sep;25(3):379-89.
  • Curtis GM, Lam SW, Reddy AJ, Bauer SR. Risk Factors Associated with Bleeding After Alteplase Administration for Pulmonary Embolism: A Case-Control Study. Pharmacotherapy. 2014 Aug;34(8):818-25.
  • Bozbay M, Uyarel H, Avsar S, Oz A, Keskin M, Tanik VO et al. Creatinine kinase isoenzyme–MB: A simple prognostic biomarker in patients with pulmonary embolism treated with thrombolytic therapy. J Crit Care. 2015 Dec;30(6):1179-83.
  • Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M. Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial). Am J Cardiol. 2013 Jan 15;111(2):273-7.
There are 9 citations in total.

Details

Primary Language English
Journal Section Original Articles
Authors

Omer Salt 0000-0002-5557-6627

Sule Yakar 0000-0002-0885-8445

Polat Durukan 0000-0002-8388-7166

Necmi Baykan 0000-0002-6845-9550

Nuri Tutar This is me 0000-0003-3097-4896

Mustafa Burak Sayhan This is me 0000-0001-9335-9001

Publication Date December 28, 2018
Published in Issue Year 2018 Volume: 1 Issue: 2

Cite

AMA Salt O, Yakar S, Durukan P, Baykan N, Tutar N, Sayhan MB. Analysis of Patients Received Intravenous t-PA with a Diagnosis of Acute Pulmonary Thromboembolism in Emergency Department. Anatolian J Emerg Med. December 2018;1(2):1-5.