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PULMONARY EMBOLISM: Nicolas Meneveau, Marie-France Séronde, Marie-Cécile Blonde, Pierre Legalery, Katy Didier-Petit, Florent Briand, Fiona Caulfield, François Schiele, Yvette Bernard, and Jean-Pierre Bassand Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism Chest 2006; 129: 1043-1050 [Abstract] [Full text] [PDF]

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Acute massive pulmonary embolism - the role of venous filters

Witold Z. Tomkowski, Pawel Kuca   (25 May 2006)

Acute massive pulmonary embolism - the role of venous filters 25 May 2006
Witold Z. Tomkowski, doctor Intensive Care Unit, National TB and Lung Diseases Research Institute, Warsaw, Poland, Pawel Kuca Send letter to journal: Re: Acute massive pulmonary embolism - the role of venous filters w.tomkowski{at}igichp.edu.pl Witold Z. Tomkowski, et al.	The management of acute massive pulmonary embolism remains controversial as well as treatment of patients whom thrombolysis was unsuccessful. Meneveau et al. (1) performed very interesting study dedicated to these problems and concluded that surgical embolectomy led to better outcome when compared with repeated thrombolysis. Several important issues raised with reading of this paper (1). All patients in the surgically treated group received vena cava filters (VCF), compared with only 8 of 26 patients in the remaining group. How many of these eight patients survived? What about outcome in this group? The in-hospital course was uneventful in 8 patients who have been treated with repeat thrombolysis. How many of them had VCF? The authors underscore that the in-hospital course was significantly better than that of patients who were treated with the second thrombolysis because of significant reduction in the numbers of recurrent pulmonary embolism. May be these results were achieved due to widespread insertion of vena cava filters in patients treated with embolectomy? Only one randomized trial (2) dedicated to efficacy of VCF in patients with pulmonary embolism confirmed their very good, initial beneficial effect for the prevention of pulmonary embolism but counterbalanced by an excess of recurrent deep-vein thrombosis. Taking into account data of Decousus et al. study (2), receiving answers to our questions is very important for proper interpretation of the results of the paper of Meneveau et al. (1). In our understanding of philosophy of life is better to have a chance for recurrent deep vein thrombosis due to insertion of VCF in the course of acute massive pulmonary embolism than die without these chances. References: 1. Meneveau N., Séronde M.-F., Blonde M.-C., Legalery P., Didier-Petit K., Briand F., Caulfield F., Schiele F., Bernard Y., and Bassand J.-P.: Management of Unsuccessful Thrombolysis in Acute Massive Pulmonary Embolism. Chest 129, 4: 1043-1050. 2. Decousus H., Leizorovicz A., Parent F., Page Y., Tardy B., Girard P., Laporte S., Faivre R., Charbonnier B., Barral F.-G., Huet Y., Simonneau G., The Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group: A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients with Proximal Deep-Vein Thrombosis N Engl J Med 1998; 338:409-416.