Urokinase
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Haemorrhage, hypotension and lack of efficacy: 6 case reports A case report described 3 men and 3 women aged 26–70 years, of whom, three patients exhibited lack of efficacy to fibrinolytic therapy with urokinase administered for massive pulmonary embolism (MPE) and the other three patients developed haemorrhage or arterial hypotension during fibrinolytic therapy with urokinase for MPE. Case 1 (a 37-year-old woman): The woman was hospitalised for elective right heart catheterisation. After 24 hours of the procedure, she experienced progressive cardiac failure and cardiogenic shock. Following transfer to the ICU, a presumptive diagnosis of massive pulmonary embolism (MPE) was considered. A pulseless electric activity was noted, and thus a bolus dose of urokinase 2 000 000 IU was administered via a central venous catheter. However, no response was noted. Due to unsuccessful attempt for of advanced life support (i.e. 60 min after administration of urokinase), the resuscitation was stopped, and she died eventually. Later, her biopsy findings confirmed existence of MPE. Case 2 (a 70-year-old man): The man, who had dyspnoea with chronic obstructive pulmonary disease, was hospitalised for pulmonary embolism (PE). Subsequently, he was diagnosed with deep vein thrombosis. Initially, he was treated with heparin [nonfractionated heparin] and an inferior vena cava filter was placed. On day 12 of hospitalisation, he developed sudden cardiac failure [aetiology not stated]. For advanced life support for ventricular fibrillation, he was administered a bolus dose of urokinase 1 000 000 IU [route not stated] during cardio-pulmonary resuscitation. However, he did not respond to the treatment. Case 3 (a 63-year-old man): The man, who had deep vein thrombosis of the right leg, was initially treated with low molecular weight heparin, but treatment adherence was bad. After 3 weeks, he was hospitalised for sudden respiratory distress and syncope. A diagnosis of pulmonary embolism (PE) was made. After 8 days, he experienced a cardiac arrest and for advanced life support, he was administered an IV bolus dose of urokinase 1 000 000 IU, but it was unsuccessful. Thus, the resuscitation efforts were ended and he died eventually. Case 4 (a 70-year-old woman): The woman, who had pancreatic adenocarcinoma, had undergone duodenum-pancreatectomy and cholecystectomy. Subsequently, she developed pulmonary embolism (PE) and was admitted to the ICU. However, she abruptly developed an asystole. Suspecting a diagnosis of massive PE, advanced life support was provided with IV urokinase 1 500 000 IU following which, she re-gained spontaneous circulation, but in next few hours she developed pulmonary and intra-abdominal bleeding, which was determined to be due to urokinase. Additionally, she developed anuria and arterial hypotension. After 7 hours of urokinase administration, she died [cause of death not stated]. Case 5 (a 45-year-old man): The man, who had alcoholic liver cirrhosis, had undergone orthotropic liver transplantation. After 40 days, he was
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