Angiology: Open Access
Open Access
ISSN: 2329-9495
+44 1478 350008
ISSN: 2329-9495
+44 1478 350008
Research Article - (2025)Volume 13, Issue 1
Pulmonary embolism is a potentially fatal and common complication of venous thromboembolism. Its serious form due to alteration of the hemodynamic state requires emergency treatment by thrombolysis. Through this study, we aim to evaluate the benefit of streptokinase thrombolysis in the management of pulmonary embolism with a high risk of mortality in the Cardiology department of the Ignace Deen national hospital in Conakry. We conducted a retrospective descriptive study over a period of 2 years (1 August, 2021 to 31 August, 2023) focusing on patients hospitalized for pulmonary embolism with severity criteria. The morbidity of pulmonary embolism with high mortality risk according to our study was 12.8%. The average age of our patients was 67 ± 34 years with a male predominance of 70%. The main clinical manifestations were chest pain (63.5%) and dyspnea (75%). All patients (100%) had undergone chest CT angiography for diagnostic confirmation. Thrombolysis was carried out using streptokinase in all our patients (100%). Tolerance of treatment was good without signs of hemorrhage in all patients (100%). Streptokinase thrombolysis proves to be a considerable therapeutic alternative in the management of serious pulmonary embolism in our context.
Pulmonary embolism; Thrombolysis; Streptokinase; University Hospital in Guinea
Pulmonary embolism is a potentially fatal and common complication of venous thromboembolism [1-3]. Pulmonary embolism with a high risk of mortality represents 5% to 10% of all pulmonary embolisms and it is defined by partial or total obliteration of the pulmonary artery and/or its branches responsible to hemodynamic instability [1,4]. The prevalence of this condition in our developing countries is probably underestimated due to difficulties in accessing diagnostic means [5]. The evaluation of the severity of a pulmonary embolism has evolved over the last ten years thanks to the use of prognostic and biological markers (troponin, natriuretic peptide B) and morphological (dilatation of the right cavities); thus, it is now possible to identify among the pulmonary embolisms, those who are at high risk of mortality (>15%) and embolisms at intermediate risk of mortality (3%-15%) [6]. Anticoagulant treatment is the cornerstone of the management of pulmonary embolism, however in cases of high risk of mortality, it has been demonstrated a more beneficial effect of thrombolysis on hemodynamics compared to anticoagulant treatment alone [6,7]. The objective of this work was to describe the benefit of thrombolysis with streptokinase in pulmonary embolism with a high risk of mortality.
This was a retrospective descriptive study extending from August 2021 to July 2023 covering patients hospitalized for pulmonary embolism in the Cardiology Department of the Ignace Deen National Hospital. The main inclusion criterion was the diagnosis of a pulmonary embolism confirmed by chest CT angiography and presenting among the following severity criteria: shock (systolic blood pressure <90 mmHg), syncope, signs of right ventricular failure on transthoracic echocardiography or chest CT angiography (dilatation and hypokinesia of the right ventricle, pulmonary hypertension, paradoxical septum). Thrombolysis was performed in all patients based on streptokinase preceded by corticosteroid therapy. Bridging heparin therapy was administered initially and subsequently switched to oral anticoagulation (rivaroxaban or apixaban) after 72 h. The data were collected on survey sheets, then entered using EpiData version 3.1 software. The analysis was carried out using SPSS (Statistical Package for Social Science) software in version 21. Qualitative variables are represented in the form of frequency (absolute and relative) and quantitative ones in the form of average plus or minus standard deviation. The data was collected anonymously and confidentiality was respected.
Total hospitalization n=612
Total number of confirmed embolisms
n=78 (12,74%)
Other pathologies
n=534 (87,25%)
Severe pulmonary embolism
n=10 (12,8%)
The majority of patients are in the age group of 40 to 60 years, representing half of the sample (50%). Patients over 60 years old constitute 40% of the sample, which shows a significant prevalence of elderly people. The average age of patients is 67 years, with a standard deviation of 34 years, indicating a large variability in patient ages? There is a male predominance among the patients treated with 70% of the sample (Table 1).
| Demographic characteristics | Size (n=10) | Proportions |
|---|---|---|
| 20-40 | 1 | 10 |
| 41-60 | 5 | 50 |
| > 60 | 4 | 40 |
| Average age # standard deviation | 67#34 ans | - |
| Female | 3 | 30 |
| Male | 7 | 70 |
Table 1: Distribution of patients according to sociodemographic characteristics.
All patients (100%) presented with dyspnea and chest pain, thus proving the richness of the symptoms in pulmonary embolism with a high risk of mortality in our patients [8-15]. In 60% of cases the picture was revealed by syncope. The rest of the symptoms were dominated respectively by: turgor of the jugular veins, edema of the lower limbs and hepatojugular reflux (70%, 60%, 50%). Obesity (70%) and bed rest (50%) were the most frequently found risk factors while 20% of patients had a history of surgery or recent travel (Table 2).
| Clinical characteristics | Frequency (n=10) | Proportions |
|---|---|---|
| Dyspnea | 10 | 100 |
| Chest pain | 10 | 100 |
| Syncope | 06 | 60 |
| Hemoptysis | 0 | 0 |
| Right heart failure signs | 0 | 0 |
| Hepatojugular reflux | 5 | 50 |
| Lower limb edema | 6 | 60 |
| Jugular veins turgor | 7 | 70 |
| Hepatomegaly | 0 | 0 |
| Risk factors | 0 | 0 |
| Obesity | 07 | 70 |
| Bed rest | 05 | 50 |
| Surgery-orthopedics | O2 | 20 |
| Estrogen-progestogen medications | 01 | 10 |
| Travel | 02 | 20 |
| Clinical probability | 0 | 0 |
| High | 10 | 100 |
Table 2: Distribution of clinical characteristics and risk factors in study participants.
Tachycardia was the most consistent ECG sign in all patients (100%). Right bundle branch block and right ventricular hypertrophy were observed in 80% and 70% of patients respectively. On chest CT angiography, 40% had bilateral pulmonary embolism and 50% had proximal involvement of the pulmonary artery (Table 3).
| Paraclinical characteristics | Frequency (n=10) | Proportions |
|---|---|---|
| Electrocardiogram | - | - |
| Tachycardia | 10 | 100 |
| S1Q3 | 05 | 50 |
| Right ventricular hypertrophy | 07 | 70 |
| Right bundle branch block | 08 | 80 |
| Cardiac Doppler ultrasound results | - | - |
| Right ventricle dilation | 04 | 44 |
| Pulmonary arterial hypertension | 03 | 30 |
| Paradoxical septum | 03 | 30 |
| chest CT angiography | - | - |
| Bilateral involvement | 04 | 40 |
| Proximal involvement | 05 | 50 |
| Unilateral involvement | 01 | 10 |
Table 3: Diagnostic evaluation of para-clinical parameters.
All patients (100%) had received streptokinase thrombolysis treatment with previously heparin therapy and treatment with direct oral anticoagulant in relay. The clinical outcome was favorable in all patients (100%) and no death was recorded (Table 4).
| Therapeutic characteristics | Frequency (n=10) | Proportions |
|---|---|---|
| Treatment | 0 | 0 |
| Thrombolysis | 10 | 100 |
| Heparin | 10 | 100 |
| Evolution | 0 | 0 |
| Favorable | 10 | 100 |
| Death | 0 | 0 |
Table 4: Treatment modalities and clinical evolution in patient sample.
The main limitation of our study could be linked to the small size of the sample and the fact that cases of suspected pulmonary embolism not confirmed by imaging and which could reflect cases of serious pulmonary embolism were not included in the study. The morbidity of serious pulmonary embolism represents 27.7% of all patients admitted for pulmonary embolism during the study period and the average age of our patients was 67 ± 34 years, with a clear male predominance (70%). Age over 60 years linked to the neoplastic process which constitutes a risk factor for venous thromboembolism could explain this high frequency in elderly subjects although our study was not interested in etiological research [16-21]. Other authors find a predominance of young age with the female sex, this could be explained by the diversity of risk factors in young women, notably obesity, estrogen-progestin contraception, etc [8]. All our patients were symptomatic with presentations dominated by dyspnea (75%) and chest pain (62.5%), thus indicating the richness of the symptomatology in the serious form of pulmonary embolism. Some authors report results close to ours [9]. All our patients (100%) presented hemodynamic instability and thus benefited from treatment by streptokinase thrombolysis, however none of our patients received alteplase. Our results corroborate those of some authors who also reported streptokinase thrombolysis in all patients [1,10]. We have not recorded any major complications following streptokinase thrombolysis in our patients with an efficacy rate linked to survival of 100%. We explained these results on the one hand by the early treatment of patients and on the other hand, by the fact that streptokinase, due to its affordable cost, is the thrombolytic of choice in our context and in the event of early treatment and compliance with treatment protocols, complications can be minimized or even avoided in return for considerable effectiveness. Whatever thrombolytic used and the administration protocol, the major risk is hemorrhagic accident [22-25].
The suspicion of pulmonary embolism must arouse the attention of the clinician in the face of any suggestive clinical picture in order to move towards diagnostic confirmation by imaging and organize adequate treatment. The severe form must be recognized and treated immediately by thrombolysis apart from absolute contraindications. This study shows that streptokinase may be an alternative to consider in our context in the management of pulmonary embolism with a high risk of mortality, although alteplase remains the preferred indication.
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Citation: Yaya BE, Sory BI, Mamadama CO, Abdoulaye B, Binta KF, Abdoulaye T, et al. (2025). Streptokinase Thrombolysis in Pulmonary Embolism with High Risk of Mortality: Case of the Cardiology Department of the National Ignace Deen Teaching Hospital in Conakry. Angiol Open Access. 13:538.
Received: 17-Dec-2024, Manuscript No. AOA-24-35934; Editor assigned: 20-Dec-2024, Pre QC No. AOA-24-35934 (PQ); Reviewed: 03-Jan-2025, QC No. AOA-24-35934; Revised: 10-Jan-2025, Manuscript No. AOA-24-35934 (R); Published: 17-Jan-2025 , DOI: 10.35841/2329-9495.25.13.538
Copyright: © 2025 Yaya BE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.