Low-dose Systemic Tissue-type-plasminogen-activator Compared to Conventional Anti-coagulation for the Treatment of Intermediate-high Risk Pulmonary Embolism.

Alan De la Rosa, Adrian Rojas Murguia, Michael J Brockman, Debabrata Mukherjee, Manu Rajachandran, Nils P Nickel
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Abstract

Background: Pulmonary embolism (PE) is a frequent cause of death. Acute PE may be treated either with full anticoagulation (AC) alone or thrombolytic therapy with systemic tissue-- type-plasminogen-activator (tPA) based on risk assessment. Currently, AC is the standard of care for most patients with intermediate-high-risk PE, with low-dose tPA emerging as an effective alternative. However, studies directly comparing the efficacy and safety of low-dose tPA to AC are lacking in this patient population.

Objective: The aim of this study was to retrospectively compare the efficacy and safety of low-- dose tPA, compared to AC alone in right ventricular function and in-hospital mortality and bleeding complications in patients presenting with intermediate-high risk PE.

Methods: This is a single-center, retrospective cohort trial conducted at a university hospital. A total of 148 patients were screened, and 88 patients qualified for this study. The primary endpoints were changes in right ventricular function on echocardiogram in 24 hours, in-hospital mortality, and major bleeding complications.

Results: Eighty-eight consecutive patients with intermediate high-risk PE were included. Twenty- six patients (29.5%) received low-dose systemic tPA administered via intravenous infusion, and 62 patients (70.4%) received standard full-dose anticoagulation. There were no significant differences in baseline vital signs or PESI scores between the low-dose tPA and the AC group. Patients in the low-dose tPA group had worse RV function and higher troponin levels at baseline but showed significant improvement in all RV parameters assessed during the 24-hour follow-up. In comparison, there was no significant improvement in RV function in the AC group. There were more bleeding events in the AC group. LOS was shorter in the low-dose tPA group.

Conclusion: Treatment with low-dose prolonged infusion of tPA may be an effective and safe therapy in patients with intermediate-risk PE. Compared to AC, low-dose tPA was effective in decreasing PASP and restoration of RV function.

低剂量全身组织型纤溶酶原激活剂与常规抗凝治疗中高危肺栓塞的比较。
背景:肺栓塞(PE)是常见的死亡原因。急性PE的治疗可根据风险评估,采用单独的全面抗凝(AC)或全身组织型纤溶酶原激活剂(tPA)溶栓治疗。目前,AC是大多数中高危PE患者的标准治疗方案,低剂量tPA是一种有效的替代方案。然而,直接比较低剂量tPA与AC的疗效和安全性的研究在这一患者群体中缺乏。目的:本研究的目的是回顾性比较低剂量tPA与单独AC在中高危PE患者右心室功能、住院死亡率和出血并发症方面的疗效和安全性。方法:这是一项在大学医院进行的单中心、回顾性队列试验。共筛选了148例患者,其中88例患者符合本研究的条件。主要终点是24小时内超声心动图右心室功能的变化、住院死亡率和大出血并发症。结果:连续88例中高危PE患者入组。26例(29.5%)患者接受静脉输注低剂量全身tPA治疗,62例(70.4%)患者接受标准全剂量抗凝治疗。低剂量tPA组和AC组在基线生命体征和PESI评分上没有显著差异。低剂量tPA组患者在基线时右心室功能较差,肌钙蛋白水平较高,但在24小时随访期间评估的所有右心室参数均有显著改善。相比之下,AC组右心室功能无明显改善。AC组出血事件较多。低剂量tPA组的LOS较短。结论:低剂量长时间输注tPA治疗中危性PE是一种安全有效的治疗方法。与AC相比,低剂量tPA能有效降低PASP,恢复RV功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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