Emergency Thrombolysis?

[parame]

The Lancet has published an interesting worldwide study on January 31st. Since one can't find the original full text online, here's an abstract by the UM Med school:

[web:b86889f84e]http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/01-31-2008/0004747381&EDATE=[/web:b86889f84e]

Now, some may think that if this subject is neglected in preventive medicine, who are we in ambulatory one to address it... but I think it is interesting and hope to hear new ideas in our scope of practice. I am sure there are different ways of thinking from around the world...

What are your opinions?

[zippyRN]

thrombolysis ( of MI, massive PE or stroke) has very little to do with VTE prevention ...

[Eydawn]

Seems to me I've seen this before.. I think what I got from it was that you can't use thrombolytics to *prevent* VTE... you can only use them to treat the acute problems caused by the clot detaching and lodging somewhere it shouldn't (like, oh... the lungs? The heart?)

Thrombolytics are an intervention that's used AFTER the problem... aren't there other, more effective therapies to treat narrowing vascular systems and embolus formation? I thought it was shown that thrombolytics are a dangerous class of drugs, thus only to be used when you know you've got an acute crisis due to a thrown clot causing occlusion. I was under the impression that other drug therapies were more effective prophylactically...

I can't remember the other article I read on it. It was a year or so ago. But that very issue was addressed... and the popular news media in some outlets took it as "the evil government regulated doctors aren't doing all they can to keep Gramma from getting a stroke after surgery"... I remember it pissed me off, lol.

Anyone else? I'm not tracking clearly enough to explain my thought processes here...

Wendy

CO EMT-B

[Doczilla]

The study is not referring to thrombolytics (tPA, streptokinase, tenecteplase). It is referring to antithrombotics (heparin, low molecular weight heparin, or bivalirudin) along with mechanical sequential compression dressings.

Thrombolytics dissolve clots such as those in acute stroke, MI, or massive hemodynamically unstable PE.

Antithrombotics and sequential compression dressings prevent clot formation and propagation. They can be used to treat DVT and PE by preventing clot propagation, and the body's natural thrombolytic mechanisms dissolve the clot.

And Eyedawn, DVTs don't lodge in the heart unless there is a septal defect.

'zilla

[JPINFV]

And Eyedawn, DVTs don't lodge in the heart unless there is a septal defect.

Foramen ovale for the loss [yes, I have an anatomy exam on Friday...].

[parame]

Thank you Doc, I appreciate the lesson.

I sinned twice for this article: I was hoping for it to just be an excuse for such debate, which is disrespect to the researchers, and also applied the wrong process name being a smartass (or a fool). I apologize for both.

I am ashamed as it exposed my own ignorance.

Maybe “EMTCity Administrator” or “AKflightmedic” can change the name of this thread so it fits? How does one contact them?

[Eydawn]

Doczilla, I knew that you had to have a septal defect for that to occur... but aren't there many people in the world who have silent, small defects like that? I thought that was fairly common, as far as heart defects go. Heck, my roommate in college had a septal defect.

Wendy

CO EMT-B

[Doczilla]

Paradoxical emboli are rarely diagnosed and rarely suspected. There are plenty of folks with silent asymptomatic septal defects. Paradoxical embolus requires not only a septal defect, such as a PFO, but also requires right-to-left shunting in the heart.

'zilla

Edited for clarity.

[KSEMT122]

I think in a Pre-Hopsital setting maybe we could be more aware of somebody that may be at higher risk for DVT's and so forth by taking a good history. I'm just glad this subject has made it onto EMT City. I'd like to state for the record that young people can also form DVT's and we as providers may not catch on to that due to their age. I can tell you from experience that my wife was almost killed by ER Doctors who failed to diagnose and treat her massive DVT and 2 Pulmonary Embolisms. She was seen twice! And they failed to diagnose her both times. Even with me beating the PE and DVT drum they failed. Let's all make sure to give our patients our utmost attention and get detailed accurate histories. Don't forget to ask about possible genetic disorders that can cause clotting and things such as that. I feel that is where we should be at in a pre-hospital setting in aiding the treatment of any type of clot. Sorry to ramble, but it's a subject close to my heart.

[EMT City Administrator]

Maybe “EMTCity Administrator” or “AKflightmedic” can change the name of this thread so it fits? How does one contact them?

Without reading the whole thing, what would you like it to be renamed?