الفهرس 
HaemostasisOnly 14 pages are availabe for public view
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Abstract
Introduction: Pulmonary embolism (PE) and deep venous thrombosis (DVT), collectively referred to as venous thromboembolism (VTE) are common disorders associated with substantial morbidity and mortality, autopsy series have shown that PE is responsible for 15% of all in hospital deaths. Thrombolysis is an established treatment for patients with acute massive pulmonary embolism and haemodynamic instability. In contrast, the effect of thrombolytic agents on the outcome of haemodynamically stable patients who have submassive PE has been debated for decades. Aim of work: The aim of our study is to evaluate the effect of high dose streptokinase (SK) in one hour versus low dose SK in 24 hours in acute massive and submassive PE. Patients and methods: This study included 50 patients admitted to Mansoura University Hospitals with pulmonary thrombo-embolism in the period between September 2003 to January 2007, 25 males (50%) and 25 females (50%), age ranged from 22 - 75 years with mean age 45.5 + 13.6 years. Patients diagnosed as pulmonary embolism by spiral CT or multislice CT chest. Patients classified according to severity into: Massive PE (6 cases): The principle criteria for categorizing PE as massive PE are arterial hypotension and cardiogenic shock. Arterial hyoptension is defined as a systolic arterial pressure < 90 mmHg or a drop in systolic arterial pressure of at least 40 mmHg for at least 15 minutes. Submassive PE (44 cases): It means normal blood pressure with evidence of pulmonary hypertension and/or right ventricular dysfunction including right ventricular hypokinesis or dilatation, interventricular septal flattening and paradoxical septal motion, and/or an elevated transtricuspid gradient Results: PE incidence increases with age above 40 years. Immobilization is the most important risk factor for PE, contributed for 60%. Dyspnea was the most clinical presentation among our cases (96%) followed by chest pain and haemoptysis. Tachypnea and tachycardia presented in most cases (76%) and (72%) respectively. PaO2 < 80 mmHg presented in 96% and increased alveolar-arterial oxygen gradient in 98%, this is indicative that hypoxemia and increased alveolar-arterial oxygen gradient highly suggestive for presence of PE but their normal value do not exclude the diagnosis. Tachycardia was the most frequent arrhythmia in PE (72%) while, S1Q3T3 present in only (36%) of cases. Normal chest x-ray does not exclude PE, in our study normal chest x-ray presented in 22% of cases. Conclusions: The clinical improvement in thrombolytic group and anticoagulant group was equivalent as evidenced by significant improvement in HR, RR, blood pressure and ABGs. SK can rapidly reverse pulmonary hypertension and RVD while in anticoagulant group there was slight improvement only in PAP.