Acute Pulmonary Embolism - Current Problems in by Paul D. Stein, MD, and Fadi Matta, MD

By Paul D. Stein, MD, and Fadi Matta, MD

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Sample text

157 There is no evidence that fibrin specific agents such as r-tPA are more effective than non-fibrin-specific agents such as streptokinase or urokinase, and there is no evidence that a bolus injection of r-tPA is any more effective than an infusion. 202 Data with the Amplatz catheter and rheolytic catheters, when used alone, were sparse or absent. 202 Minor bleeding at the insertion site among all patients, with and without thrombolytic agents, occurred in 8% and major bleeding at the insertion site occurred in 3%.

157 Early Discharge Large proportions of patients with a primary diagnosis of PE and of DVT are being discharged before adequate heparin can be administered and before warfarin can become antithrombotic171 (Fig 25). 173,174 Subsequent investigations supported the outpatient approach to the treatment of DVT. Patients with PE were excluded from most investigations of outpatient treatment of DVT or treatment of DVT after early discharge. PE is a more ominous and potentially fatal form of Curr Probl Cardiol, July 2010 355 FIG 25.

5 11a — — — 10 — 5-10 10 — — — 29-55 11 a Prevalence of disorder among whites in general population. Abbreviations: DVT, deep venous thrombosis; VTE, venous thromboembolism. 10 Intermittent Pneumatic Compression Intermittent pneumatic compression is effective in reducing the frequency of DVT (Tables 15 and 16). Following neurosurgery, intermittent pneumatic compression is particularly useful because there is no risk of bleeding with this procedure. 146 Intermittent pneumatic compression and LMWH have not been directly compared in prospective investigations.

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