The Analysis of Long-Term Results and Quality of Life in Patients with Massive Pulmonary Embolism in the Course of Treatment with Thrombolytic and Anticoagulant Drugs

Relevance Chronic post-embolic pulmonary hypertension (CPEPH) is a complication of pulmonary thromboembolism found almost in every 10th patient. A special risk group consists of patients with a moderately high risk of pulmonary embolism associated death according to stratification of the probability of early death of the European Society of Cardiology. The development of this condition is potentially preventable with timely and adequate therapy in these patients. We have improved the approach to the treatment of pulmonary embolism patients, which allows indications for thrombolytic therapy to be clarified and expanded. The aim of the study is to evaluate its effectiveness in the long-term period, as well as analyze the qualities of life of patients with massive pulmonary embolism, who underwent thrombolytic and anticoagulant therapy.

Material and methods The treatment, as well as the analysis of long-term results and quality of life of 71 patients aged 29 to 88 years with diagnosed pulmonary embolism with a moderately high risk of early death were performed. All patients underwent general clinical and biochemical blood tests, D-dimer, ECG, echocardiography, ultrasound of the lower extremities veins, CT angiopulmonography. We registered the dynamics of echocardiographic symptoms of the right heart overload over 6 months (right ventricle size, pulmonary hypertension, the degree of tricuspid regurgitation), and assessed the quality of life based on a survey with the establishment of the appearance of shortness of breath, tachycardia, hospitalizations for heart failure during the study period. Depending on the type of therapy, the patients were divided into two groups: 38 patients with thrombolytic therapy and 33 patients with anticoagulant therapy. Subsequently, their comparative analysis was carried out.

Results and conclusion In patients with pulmonary embolism of moderately high risk of early death, who underwent thrombolytic therapy, chronic postembolic pulmonary hypertension developed 2.9 times less and a higher quality of life retained in these patients than in patients treated with anticoagulant drugs.

1. Chazova IE, Martynyuk TV. Problems of diagnosis and treatment of chronic thromboembolic pulmonary hypertension. Pacific Medical Journal. 2017;(4):6–16.

2. Oh SJ, Bok JS, Hwang HY, Kim KH, Kim KB, Ahn H. Clinical Outcomes of Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: 12-Year Experience. Korean J Thorac Cardiovasc. 2013;46(1):41–48. PMID: 23423163 http://doi.org/10.5090/kjtcs.2013.46.1.41

3. Sidorenko BA, Preobrazhenskiy DV, Batyraliev TA, Belenkov YuN. Legochnaya arterial’naya gipertenziya: izmenyayushchiesya podkhody k lecheniyu. Kardiologiia. 2011;(1):100–108. (in Russ.)

4. Bigdelu L, Azari A., Fazlinezhad A. Assessment of Right Ventricular Function by Tissue Doppler, Strain and Strain Rate Imaging in Patients with Left-Sided Valvular Heart Disease and Pulmonary Hypertension. Archives of Cardiovascular Imaginging. 2014;2(1):1337–1342. http://doi.org/10.5812/acvi.13737

5. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119. PMID: 26320113 http://doi.org/10.1093/eurheartj/ehv317

6. Chernyavskiy AM, Edemskiy AG, Chernyavskiy MA, Karas’kov AM. Khronicheskaya postembolicheskaya legochnaya gipertenziya. In: Avdeev SN, Aldashev AA, Gorbachevskiy SV, Edemskiy AG, Karas’kov AM, Korobkova IZ, et al. Khronicheskaya postembolicheskaya legochnaya gipertenziya. Moscow: GEOTAR-Media Publ.; 2015. Pt.11. (in Russ.)

7. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033–3069. PMID: 25173341 http://doi.org/10.1093/eurheartj/ehu283

8. Fareed J. Antithrombotic therapy in 2014: making headway in anticoagulant and antiplatelet therapy. Nat Rev Cardiol. 2015;12(2):70– 71. PMID: 25583622 http://doi.org/10.1038/nrcardio.2014.222

9. Konstantinides SV, Vicaut E, Danays T, Becattini C, Bertoletti L, Beyer-Westendorf J. Impact of thrombolytic therapy on the long-term outcome of intermediate-risk pulmonary embolism. J Am Coll Cardiol. 2017;69(12):1536–1544. PMID: 28335835 http://doi.org/10.1016/j.jacc.2016.12.039

10. Djordjikia RK, Belyaev AR, Lukanihin VA, et al. Features of diagnosis and treatment of deep vein thrombosis. The Bulletin of Contemporary Clinical Medicine. 2013;(5): 143–145. (in Russ.)

11. Tyurin VP, Pronin AG. The enlargement of indications for thrombolytic therapy in patients with pulmonary embolism. Bulletin of Pirogov National Medical & Surgical Center. 2018;(4):85–90. (in Russ.)