TY - JOUR N2 - 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. L1 - http://www.czasopisma.pan.pl/Content/109689/PDF/FMC%204-18%207-Furdyna.pdf L2 - http://www.czasopisma.pan.pl/Content/109689 PY - 2018 IS - No 4 EP - 83 DO - 10.24425/fmc.2018.125705 KW - acute pulmonary embolism KW - high-risk pulmonary embolism KW - thrombolysis KW - embolectomy A1 - Furdyna, Aleksandra A1 - Ciurzyński, Michał A1 - Roik, Marek A1 - Paczyńska, Marzanna A1 - Wretowski, Dominik A1 - Jankowski, Krzysztof A1 - Lipińska, Anna A1 - Bienias, Piotr A1 - Kostrubiec, Maciej A1 - Łabyk, Andrzej A1 - Trzebicki, Janusz A1 - Palczewski, Piotr A1 - Kurnicka, Katarzyna A1 - Lichodziejewska, Barbara A1 - Pacho, Szymon A1 - Pruszczyk, Piotr PB - Oddział PAN w Krakowie; Uniwersytet Jagielloński – Collegium Medicum VL - vol. 58 DA - 2018.12.15 T1 - Management of high risk pulmonary embolism — a single center experience SP - 75 UR - http://www.czasopisma.pan.pl/dlibra/publication/edition/109689 T2 - Folia Medica Cracoviensia ER -