Enes Elvin GÜL, Turyan ABDULHALIKOV, Yusuf ALİHANOĞLU, Mehmet YAZICI, Osman SÖNMEZ, Mehmet KAYRAK

A successful thrombolysis with tissue-type plasminogen activator in a case of pulmonary embolism after failed streptokinase therapy

Alt ekstremite derin ven trombozuna bağlı oluşan akut, masif pulmoner emboli tanısı konmuş 76 yaşında erkek hastada ciddi kardiyovasküler ve solunumsal instabilite gelişti. Takiben hastaya iki saat süreyle streptokinaz infüzyonu verildi. Trombolitik tedavi sonrası hemodinamik kararsızlığın devam etmesi üzerine, spiral bilgisayarlı tomografi çekildi. Bilgisayarlı tomografi, masif pulmoner embolinin sebat ettiğini gösterdi. Literatür verileri ışığında hastaya cerrahi pulmoner embolektomi önerildi; ancak hasta cerrahiyi reddetti. Bunun üzerine hastaya iki saat süreyle intravenöz rekombinant doku tipi plazminojen aktivatörü verildi. Tedavi sonrasında hastanın klinik durumu ve radyolojik bulguları belirgin olarak düzeldi. Hasta efektif antikoagülan tedavi ile taburcu edildi.

Başarısız streptokinaz tedavisi sonrası pulmoner embolili bir olguda doku tipi plasminojen aktivatör ile başarılı tromboliz

A 76-year-old male patient diagnosed with acute, massive pulmonary embolism due to deep vein thrombosis of a lower extremity developed significant cardiovascular and respiratory instability. Subsequently, streptokinase infusion was administered over two hours. Spiral computed tomography was performed due to the persistent hemodynamic instability following the thrombolytic therapy. Computed tomography showed persistent massive pulmonary embolism. In the light of literature data, the patient was recommended for surgical pulmonary embolectomy, however he refused surgery. Therefore, he was administered intravenous recombinant tissue type plasminogen activator over two hours. Clinic status of the patient and radiological findings were significantly improved following therapy. The patient was discharged with effective anticoagulant therapy.

PDF

___

1. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003;163:1711-7.
2. Goldhaber SZ. Pulmonary embolism. N Engl J Med 1998;339:93-104.
3. Konstantinides S. Clinical practice. Acute pulmonary embolism. N Engl J Med 2008;359:2804-13.
4. Meneveau N, Séronde MF, Blonde MC, Legalery P, Didier- Petit K, Briand F, et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 2006;129:1043-50.
5. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet 1999;353:1386-9.
6. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165-71.
7. Collen D, Stassen JM, Verstraete M. Thrombolysis with human extrinsic (tissue-type) plasminogen activator in rabbits with experimental jugular vein thrombosis. Effect of molecular form and dose of activator, age of the thrombus, and route of administration. J Clin Invest 1983;71:368-76.
8. Agnelli G, Buchanan MR, Fernandez F, Boneu B, Van Ryn J, Hirsh J, et al. A comparison of the thrombolytic and hemorrhagic effects of tissue-type plasminogen activator and streptokinase in rabbits. Circulation 1985;72:178-82.
9. Meneveau N, Schiele F, Metz D, Valette B, Attali P, Vuillemenot A, et al. Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up. J Am Coll Cardiol 1998;31:1057-63.
10. Goldhaber SZ, Kessler CM, Heit J, Markis J, Sharma GV, Dawley D, Nagel, et al. Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 1988;2:293-8.