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28.04.2020

Thrombolysis in massive and submassive pulmonary embolism during pregnancy and the puerperium: a systematic review

verfasst von: David Rodriguez, Carlos Jerjes-Sanchez, Sugely Fonseca, Rebeca Garcia-Toto, Jhon Martinez-Alvarado, Jathniel Panneflek, Claudia Ortiz-Ledesma, Francisco Nevarez

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 4/2020

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Abstract

Thrombolysis in high-risk pulmonary embolism (PE) patients is recommended worldwide; however, the evidence for thrombolysis during pregnancy and the immediate puerperium remains unclear. We conducted a systematic review from 1950 to 2019 through PubMed, Ovid/Willey, and Cochrane Library to assess the safety and effectiveness of thrombolysis during pregnancy and the immediate puerperium. Additionally, we characterized the clinical presentation, risk stratification, and diagnostic approach. We have communicated our results according to the PRISMA statement. We collected 141 records and, after critical assessment, included 47 case reports of 54 patients, including 43 and 11 patients during pregnancy and puerperium, respectively. During pregnancy, alteplase was the most frequent systemic thrombolytic agent used (67%), but only nine patients received the approved FDA regimen. With catheter-directed thrombolysis, low-dose thrombolytics and fragmentation were the most common regimens. Major bleeding occurred in 18% of cases, but there was no intracranial bleeding. One maternal death occurred secondary to refractory cardiogenic shock. Fetal mortality was 20%. During the immediate puerperium, nine patients received “off-label” first-, second-, and third-generation thrombolytic regimens, and four cases underwent catheter-directed thrombolysis. We observed nine major bleeding events, seven of which were from the uterine location and none of which were intracranial. In conclusion, overall, these data do not suggest prohibitive risk associated with thrombolysis for PE in pregnancy. Management of massive and high-risk submassive PE in pregnancy should be individualized to each patient. In the data presented, no fatal bleeding or intracranial bleeding was observed. Finally, future efforts should systematically collect and report data on high-risk PE in pregnancy and peripartum patients to improve the evidence-base clinical practice.

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Titel: Thrombolysis in massive and submassive pulmonary embolism during pregnancy and the puerperium: a systematic review
verfasst von: David Rodriguez
Carlos Jerjes-Sanchez
Sugely Fonseca
Rebeca Garcia-Toto
Jhon Martinez-Alvarado
Jathniel Panneflek
Claudia Ortiz-Ledesma
Francisco Nevarez
Publikationsdatum: 28.04.2020
Verlag: Springer US
Erschienen in: Journal of Thrombosis and Thrombolysis / Ausgabe 4/2020
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-020-02122-7

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