Brief Article
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World J Cardiol. May 26, 2013; 5(5): 141-147
Published online May 26, 2013. doi: 10.4330/wjc.v5.i5.141
Mechanical breakdown and thrombolysis in subacute massive pulmonary embolism: A prospective trial
Bishav Mohan, Shibba Takkar Chhabra, Naved Aslam, Gurpreet Singh Wander, Naresh Kumar Sood, Sumati Verma, Anil Kumar Mehra, Sarit Sharma
Bishav Mohan, Shibba Takkar Chhabra, Naved Aslam, Gurpreet Singh Wander, Naresh Kumar Sood, Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana141001, Punjab, India
Sumati Verma, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Anil Kumar Mehra, Department of Medicine, Keck School of Medicine, LAC-USC Medical Center, Los Angeles, CA 90033, United States
Sarit Sharma, Department of Social and Preventive Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Author contributions: Mohan B conceived the idea and performed mechanical breakdown and thrombolysis in these patients and guided the project; Chhabra ST involved in case selection, data analysis, procedural assistant and review of literature initially as a fellow in cardiology and then as assistant professor during the follow up phase; Verma S involved in case selection and review of literature as a medical intern; Sharma S involved in statistical analysis of data as an associate professor in department of social and preventive medicine; Aslam N, Sood NK and Wander GS associated team of interventional cardiologists who were actively involved in assisting the procedures and supervised the study; Mehra AK visited interventional cardiologist who assisted the cases and guided data analysis and the completion of the project.
Correspondence to: Bishav Mohan, Professor, Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. bishav_68@yahoo.co.in
Telephone: +91-161-203428287-381 Fax: +91-161-2309595
Received: February 11, 2013
Revised: April 24, 2013
Accepted: May 8, 2013
Published online: May 26, 2013
Processing time: 103 Days and 7.3 Hours
Core Tip

Core tip: Patients with massive pulmonary embolism presenting subacutely (> 2 wk) have high mortality and older clots in these patients may be less amenable to thrombolysis with increased likelihood of recurrence and thromboembolic pulmonary hypertension. Eight of 70 patients with massive pulmonary embolism presenting subacutely were subjected to mechanical breakdown and intra lesional thrombolysis with urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h). Post procedurally, patients documented significant improvement in hemodynamic parameters with 100% survival at 30 d and 6 mo followup. This modality appears to be a promising alternative to high risk surgical procedures in such patients.