Exploring the Role of Sildenafil in Acute Pulmonary Embolism

Hall H, Orton C, Mirza R, Shaw E, Ryan K and Madden BP

Department of Cardiothoracic Medicine, St George’s University Hospitals NHS Foundation Trust, UK

^*Correspondance to: Helen Hall 

 PDF  Full Text DOI: 10.25107/2474-1647.1963

Abstract

Acute pulmonary embolism is a cause of significant morbidity and mortality. If thrombus burden is sufficient as to cause right ventricular strain, even “intermediate-high risk”, normotensive patients have a 13% risk of death at 3 months. Current trials do not support thrombolysis in this group due to excess risk of bleeding. Novel strategies to support the haemodynamic response to acute PE may be advantageous. We report our experiences of using Sildenafil in high or intermediate-high risk PE. 18 patients took Sildenafil 25 mg thrice daily for >3 months. A further patient received 12.5 mg thrice daily with dose reduction due to side effects. Despite markers of poor prognosis at presentation, all patients survived to 3 months. 7 received systemic thrombolysis, but none required invasive ventilation or advanced haemodynamic support. Now at median 9 months follow up, 2 cases of CTEPH have been confirmed. There have been no deaths directly attributable to thromboembolic disease. Our findings demonstrate Sildenafil to be a safe, generally well-tolerated adjunct to standard treatment in this group. Larger controlled trials are now required to better ascertain the role of Sildenafil in this context.

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Cite the article

Hall H, Orton C, Mirza R, Shaw E, Ryan K, Madden BP. Exploring the Role of Sildenafil in Acute Pulmonary Embolism. Clin Surg. 2018; 3: 1963.