Use of thrombolytic therapy and rheolytic thrombectomy in treatment of pulmonary artery thromboembolism

Kokov L.S.¹, Matveev P.D.¹, Nikitina O.V.¹, Lopotovsky P.Yu.¹, Kosolapov D.A.¹, Kudryashova N.E.¹, Migunova E.V.¹, Mikhailov I.P.¹, Sharifullin F.A.¹, Ayazyan D.A.²

1) Scientific Research Institute of Emergency Ambulance Care named after N.V. Sklifosovsky, Moscow, Russia,
2) VUMC University Medical Center, Amsterdam, Netherlands

The article deals with the results of combined treatment of patients with pulmonary thromboembolism by means of systemic thrombolytic therapy, anticoagulant therapy, and rheolytic thrombectomy during the period from 2012 to 2013.

Thrombolytic therapy was used in 78 of 187 patients with the confirmed diagnosis of pulmonary thromboembolism (Group 1). The diagnosis was verified and therapeutic results were controlled by means of contrast-enhanced spiral computed tomography and perfusion scintigraphy. Thrombolysis was carried out using: tissue plasminogen activator – alteplase (61 cases) with administration of the full dose during 2 hours, streptokinase (14 cases) at a dose of 1.5 million IU in the mode of prolonged infusion during 24 hours and urokinase (3 cases) at a dose of 4400 IU/kg during 12 hours. 109 patients were subjected to anticoagulant therapy (Group 2).

Five patients were subjected to rheolytic thrombectomy for desobstruction of the pulmonary artery. The method was used in patients with previously performed ineffective or partially effective thrombolytic therapy, as well as in patients with contraindications to thrombolysis.

The lethality rate for TLT amounted to 5.4% and that for anticoagulant therapy 26.6%. Probability of a lethal outcome in Group 2 (anticoagulant therapy) turned out to be 6.71 times higher as compared with Group 1 (thrombolytic therapy).

In all cases of using rheolytic thrombectomy we managed to achieve a decrease of the Miller index and systolic pressure in the pulmonary artery. Desobstruction of the pulmonary artery was complete in 3 cases. In two cases rheolytic thrombectomy was partially effective and the patients underwent repeat thrombolysis with a good clinical outcome.

Using systemic thrombolysis in patients with pulmonary artery thromboembolism demonstrated a positive effect on the prognosis of survival. Rheolytic thrombectomy contributed to improvement of the results of thrombolytic therapy and may be used as an alternative method of treatment.

KEY WORDS: pulmonary artery thromboembolism, thrombolytic therapy, anticoagulant therapy, rheolytic thrombectomy.

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