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The pulmonary embolism (PE) represents a medical condition with increasing incidence. The various clinical forms of PE have different prognosis, related to the presence of markers of right ventricle (RV) dysfunction (biochemical or imagistic). Material and method. In this study we included 82 consecutive patients with intermediate-high risk PE, assessing the main risk factors distribution. We divided the patients in two groups, study group - receiving thrombolytic therapy (ateplase (t-Pa)) associated to anticoagulation (unfractionated heparin (UFH)) – and control group – receiving anticoagulation alone -. The inclusion in study group was indicated by the high bleeding risk, in this group being included patients without contraindications for thrombolysis, patients without severe renal dysfunction and patients with body mass index (BMI) 18.5-29.9 kg/m2. We assessed the gender distribution in the two groups, the medium age distribution and the main PE risk factors in the two groups. Also, we assessed the effect of the both therapies on the hemodynamic instability rate on 7 day from admission (defined by systolic blood pressure (SBP) < 100 mmHg or a SBP drop >40 mmHg from inclusion value). The statistical analysis was made using SPSS program, by comparing the association between risk factors and the two groups, by Chi-squared test, while the gender and age distribution was made using the Shapiro Wilk test for the evenly data distribution and Wilk test (as the data were unevenly distributed). Results. We found no correlation between the risk factors and the study groups. There was no statistical significance regarding the gender distribution, but the medium age was higher in control group (61.82 y.o vs. 71.28 y.o, p < 0.001. Regarding the hemodynamic instability rate the Chi-squared test proved a statistical significant higher incidence in the control group (p = 0.03).

The objective of the study is to assess the efect of thrombolitic therapy on clinical prognostic markers in patients with intermediate-high risk pulmonary embolism compared to clasic therapy, and also the assessment of the bleeding risk associated with thrombolitic therapy. Material and methods. We included 82 consecutive patients with intermediate-high risk pulmonary embolism, which were divided in two groups: study group (thrombolysed) and control group (treated with unfractioned heparine alone). Patients with lower bleeding risk were included in control group. Patients were assessed regarding the right ventricle dysfunction markers (both imagistic and biochemical) on admision and on 48 h. The early (7th day) mortality rate and hemodinamic instability rate were evaluated in the two groups, also the major bleeding rate. Outcomes. We proved a statistical significant lower mortality rate in the study group, with no difference regarding the major bleedings. Meanwhile, the hemodinamic instability was lower in the study group compared to control group. Conclusions. The proper patient selection with intermediate-high pulmonary embolism for thrombolitic therapy can bring important benefits in terms of mortality and bleeding complications

Background and objectives: One of the leading causes of mortality and morbidity in people over the age of 50 is stroke. The acceptance of transcatheter aortic valve replacement (TAVR) as a treatment option for severe symptomatic aortic stenosis (AS) has increased as a result of numerous randomized clinical trials comparing surgical aortic valve replacement (SAVR) and TAVR in high- and intermediate-risk patients, showing comparable clinical outcomes and valve hemodynamics. Materials and Methods: An electronic search of Medline, Google Scholar and Cochrane Central was carried out from their inception to 28 September 2022 without any language restrictions. Results: Our meta-analysis demonstrated that, as compared with SAVR, TAVR was not linked with a lower stroke ratio or stroke mortality. It is clear from this that the SAVR intervention techniques applied in the six studies were successful in reducing cardiogenic consequences over time. Conclusions: A significantly decreased rate of mortality from cardiogenic causes was associated with SAVR. Additionally, when TAVR and SAVR were compared for stroke mortality, the results were nonsignificant with a p value of 0.57, indicating that none of these procedures could decrease stroke-related mortality.

Objectives. The objective of this study is to assess the impact of the thrombolytic therapy in patients with intermediary-high risk PE. The analysis was focused on the impact on echocardiographic and biochemical markers of right ventricle (RV) pressure overload and also on mortality and haemodynamic instability. Materials and methods. In the present, study we selected patients with intermediary-high risk pulmonary embolism, selected either for thrombolytic therapy (alteplase - t-PA - plus unfractionated heparin) or for therapy only with unfractionated heparin (UFH). The patients included in the study group did not have contraindications for thrombolysis, were younger than 75 years old, did not have severe renal failure - creatinine clearance > 30 ml/min/m2 - or severe anemic syndromes - haemoglobin > 10 g/dl in thrombolysed group. The rest of the patients were included in the control group. The echocardiographic markers of right ventricle were determined on admission and on 3 days, Nt pro BNP value was assessed on admission and on 7 days as a marker of right ventricular (RV) pressure overload. As a statistical tool for comparing the evolution of the markers in the 2 groups the t-test assuming equal variances was used. Results. The right ventricle dysfunction markers were statistically significant improved in the study group treated with thrombolytic therapy and unfractionated heparine compared to patients from the group treated with unfractionated heparine alone. The thrombolytic effect on mortality was statistically insignificant but the effect on haemodynamic stability reached the statistical significance. The major bleeding rate was higher in the thrombolysed group, not being significant compared to the control group, receiving unfractionated heparine alone. Discussions. The effect of the thrombolytic therapy on biochemical and imagistic markers of RV dysfunction demonstrates the benefit of the therapy compared to classic therapy. The impact on mortality was not statistical significant but the effect on haemodynamic instability is correlated with the effect on biochemical and imagistic markers of RV dysfunction. Conclusion. The benefic effect of the thrombolytic therapy in patients with intermediary-high risk pulmonary embolism is obvious from the presented data. The most important element is the wright selection of the patients in which the risk/benefit ratio is acceptable. [ABSTRACT FROM AUTHOR]