7 Thrombolytic therapy for venous thrombosis and pulmonary embolism

摘要: Streptokinase, urokinase, tissue plasminogen activator and similar drugs can all cause lysis of venous thrombi pulmonary emboli, but there is small evidence that accelerated achieves a significantly better clinical outcome, on average, in the shorter or longer term, than heparin alone. Thrombolytic therapy for deep leg vein thrombosis aims to restore flow preserve valves, so prevent chronic post-phlebitic disability, no trial has convincingly demonstrated last be achieved more few patients. Only minority people with extensive proximal develop disabling insufficiency, are good predictors this outcome. As result, any widespread use thrombolytics would bring an immediate risk major bleeding many who will never destined clinically important problem. after should avoided except, perhaps, carefully selected patients severe obstruction. The case using recent embolism strongest limited number ongoing hypoxia, respiratory distress, hypertension right heart failure, because thrombolytic often impressive almost benefit setting. Whether early relief from artery obstruction translates into longer-term advantage over remains uncertain, however, comparative ever shown these reduce mortality embolism. In cases, both physician patient must balance certainty against uncertainty marginal real benefit.