thrombosis and thromboembolism phần 8

Tỷ lệ lớn các tác dụng phụ tim, được định nghĩa là tử do tim, nhồi máu cơ tim, hoặc revascularization mục tiêu tổn thương xảy ra ở mức thấp, nhưng tần số, tương tự như trong mỗi nhóm điều trị, xấp xỉ 1,2% trong những người nhận được một liều tải clopidogrel cộng với điều trị duy trì, 1,5 % của những người bảo trì nhận được | Thrombolysis in PE 255 C. Registries In carefully conducted observational studies thrombolysis for PE emerges as a strategy with a higher risk of major hemorrhagic complications than is reported in controlled clinical trials. At the Laennec Hospital in Paris the group of Herve Sors reviewed the bleeding complications in 132 consecutive patients who received rt-PA for massive PE 26 . Two patients suffered intracranial bleeding and one of the two died. Pericardial tamponade was equally problematic and occurred in two other patients one of whom died. Other major bleeding complications included 2 gastrointestinal hemorrhages 3 cases of hemoptysis and 11 hematomas at the puncture site for pulmonary angiography. In ICOPER the prospective registry of 2454 patients with PE conducted in 52 hospitals among 7 countries 304 patients received thrombolytic therapy 1 . An amazingly high of patients who received thrombolysis suffered intracranial bleeding. Overall 22 of those receiving thrombolysis had major bleeding and 12 required transfusions. D. Predictors of Bleeding In an overview of the five PE thrombolysis trials that we conducted 21 27-30 the mean age of patients with major bleeding was 63 years while that of patients with no hemorrhagic complication was 56 years p . There was a 4 increased risk of bleeding for each additional year of age. Increasing body mass index and pulmonary angiography were also significant predictors of hemorrhage 31 . VII. PRACTICAL POINTS The only FDA-approved contemporary dosing regimen for PE thrombolysis is rt-PA given in a fixed dose of 100 mg as a continuous infusion over 2 h. There is no need to obtain laboratory tests during the thrombolytic infusion because no dosage adjustments are made. rt-PA administered locally within the pulmonary artery has never been shown to confer any advantage over peripheral administration of the drug 32 . A. PE Thrombolysis in Women Data from 312 patients 144 women and 168 men included in our