Results of thromboembolytic therapy in the severe pulmonary thromboembolism

pp 69-77

Abstract

Eight patients with severe pulmonary thromboembolism, in functional classes III-I V- V of Greenfield's classification (Table 1), entered this study. They were treated with systemic urokinase in two therapeutic schedules: a) 4,400 IU/kg/h for 24 hours; b) 15,000 IU/kg/ as unique dosis in 30 minutes. Risk factors on admission, functional class and the presence or not of previous cardiopulmonary disease were evaluated (Table 2). In the eight patients the diagnosis was confirmed by pulmonar angiograms, and phlebography was done in five of them (Table 3). The mean cardiac index (CI) of in charge was of 2.01 11m in, the mean pulmonary pressure (MPP) was 51 mmHg and the mean oxygen partial pressure was 52.6 mmHg. After twenty four hours following treatment with thrombolytics, all the patients reduced the pulmonary pressure (MPP: 33 mmHg those with previous cardiopulmonary disease, and 19.2 the rest; and increased their CI (3.13 II min) and the oxygen partial pressure (78.1 mmHK) (Table 4). The most common electrocardiographic changes were the right bundle branch block, and the electrocardiographic pattern of SrQIIrTm, which were reversible with thrombolytic therapy. There was no mortality due to treatment. There was only one major bleeding by the punction site, in one patient. In the patient with subsequent phlebographies, no thrombi resolution was seen. In all patients the inferior cava vein was interrupted (Table 5). In this group of patients with severe pulmonary thromboembolism with functional class III-I V- V, the thrombolytic therapy, associated to anticoagulant therapy and the inferior cava vein interruption, reduced the habitual mortality 'of this pathology. The thrombolytics improved the hemodynamic status allowing a better thrombus resolution; "giving time" to the adoption of other therapeutics.