Dr. Feras Khan is an emergency medicine trained intensivist who has recently joined the University of Maryland’s departments of both CCM and EM. Â This is a great lecture on the nuts and bolts of managing the patient with an acute PE in the ICU. Do you know the code dose of t-PA if that PE patient decompensates? Â Who should be given low-molecular weight heparin (LMWH) vs. unfractionated heparin (UFH)? Â Who gets an IVC filter? Â Well, for some of these questions you may only have a minute or two to decide – so if you aren’t sure, take 30 minutes out of your day and get some quality core-content education.
Khan – Management of Acute PE in the ICU.mp3
Pearls
- Sustained hypotension defined as a SBP < 90 is an indication for PE thrombolysis. Â How long is sustained hypotension? Â 15 Minutes.
- The risk of hemorrhagic complications secondary to PE thrombolysis is estimated to be about 20%. Â ICH post t-PA for pulmonary embolism appears to be around 1-5%.
- In patients admitted to the ICU, strongly consider UFH over LMWH for anticoagulation therapy. Â Specifically use UFH if the patient has any evidence of renal insufficiency/failure, BMI>40, or even a chance that they will need thrombolytics or surgical intervention (i.e. most ICU patients).
If you haven’t read the MOPETT Trial yet, do yourself a favor and invest at least 30 minutes in reading through this study. Â It may be a practice changing article.
Suggested Reading
- Fiumara K, Kucher N, Fanikos J, et al. Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol. 2006 Jan 1;97(1):127-9.
- Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011 Apr 26;123(16):1788-830.
