The enlargement of indications for thrombolytic therapy in patients with pulmonary embolism

In 371 patients with pulmonary embolism of high, moderately and low risk of death, the analysis was performed to establish the most significant clinical and laboratory and instrumental criteria for determining the indications for thrombolytic therapy in pulmonary embolism. The most significant clinical symptoms were hypotension with blood pressure of less than 90/60 mm Hg., syncope in history, tachycardia with heart rate of more than 100 beats per minute, saturation of arterial blood less than 90%, swelling of the veins of the neck, accent 2 tones over the pulmonary artery. For patients with pulmonary embolism complicated by development of acute pulmonary heart disease the most characterized by: dilation of the right ventricle reaches a size more than the left, hypokinesia of the right ventricle, paradoxical movement of the interventricular septum, increased pressure in the pulmonary artery of more than 50 mm Hg., the expansion of the inferior vena cava more than 20 mm by Echocardiography, increased values of troponin I and NT-proBNP levels from 1000 to 3000 pmol / ml, SIQIII symptom on ECG. The significance of these parameters for a pulmonary embolism with a massive lesion volume was confirmed by multivariate regression analysis. As a result, a scale was drawn up to make a decision on the choice of the optimal tactics of management: thrombolytic or anticoagulant therapy.