@ARTICLE{Furdyna_Aleksandra_Management_2018,
 author={Furdyna, Aleksandra and Ciurzyński, Michał and Roik, Marek and Paczyńska, Marzanna and Wretowski, Dominik and Jankowski, Krzysztof and Lipińska, Anna and Bienias, Piotr and Kostrubiec, Maciej and Łabyk, Andrzej and Trzebicki, Janusz and Palczewski, Piotr and Kurnicka, Katarzyna and Lichodziejewska, Barbara and Pacho, Szymon and Pruszczyk, Piotr},
 volume={vol. 58},
 number={No 4},
 journal={Folia Medica Cracoviensia},
 pages={75-83},
 howpublished={online},
 year={2018},
 publisher={Oddział PAN w Krakowie; Uniwersytet Jagielloński – Collegium Medicum},
 abstract={Background and Aim: Patients with acute pulmonary embolism (APE) associated with hemodynamic instability, i.e. high-risk APE (HR-APE), are at risk for early mortality and require urgent reperfusion therapy with thrombolysis or embolectomy. However, a considerable proportion of HR-APE subjects is not reperfused but only anticoagulated due to high bleeding risk. The aim of the present study was to assess the management of HR-APE in a single large-volume referral center. Methods: A single-center retrospective study of 32 HR-APE subjects identified among 823 consecutive patients hospitalized for symptomatic APE. Results: Out of 32 subjects with HR-APE (19 women, age 69 ± 19 years), 20 patients were unstable at admission and 12 subsequently deteriorated despite on-going anticoagulation. Thrombolysis was applied in 20 (62.5%) of HR-APE subjects, limited mainly by classical contraindications in the remainder. Percutaneous pulmonary embolectomy was performed in 4 patients. In-hospital PE-related mortality tended to be higher, albeit insignifi cantly, in the patients who developed hemodynamic collapse during the hospital course compared to those unstable at admission (67% vs. 40%, p = 0.14). Also, survival was slightly better in 22 patients treated with thrombolysis or percutaneous embolectomy in comparison to 10 subjects who received only anticoagulation (54% vs. 40%, p = 0.2). Major non-fatal bleedings occurred in 7 of 20 patients receiving thrombolysis (35%) and in 2 (17%) of the remaining non-thrombolysed 12 HR-APE subjects. Conclusions: Hemodynamically instability, corresponding to the definition of HR-APE, affects about 4% of patients with APE, developing during the hospital course in approximately one-third of HR-APE subjects. As almost 40% of patients with HR-APE do not receive thrombolytic therapy for fear of bleeding, urgent percutaneous catheter-assisted embolectomy may increase the percentage of patients with HR-APE undergoing reperfusion therapy. Further studies are warranted for a proper identification of initially stable intermediate-risk APE subjects at risk of hemodynamic collapse despite appropriate anticoagulation.},
 type={Artykuły / Articles},
 title={Management of high risk pulmonary embolism — a single center experience},
 URL={http://www.czasopisma.pan.pl/Content/109689/PDF/FMC%204-18%207-Furdyna.pdf},
 doi={10.24425/fmc.2018.125705},
 keywords={acute pulmonary embolism, high-risk pulmonary embolism, thrombolysis, embolectomy},
}