Effectiveness and Safety of Reduced-Dose and Slow-Infusion Intravenous Tissue-Type Plasminogen Activator Regimen in Patients with Acute Pulmonary Embolism at Intermediate-High Risk.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Barkın Kültürsay, Seda Tanyeri, Berhan Keskin, Hacer Ceren Tokgöz, Dicle Sırma, Çağdaş Buluş, Şeyma Zeynep Atıcı, Şeyma Nur Çiçek, Furkan Baturalp Erdoğan, Ahmet Sekban, Mustafa Bulut, Zübeyde Bayram, Selahattin Akyol, Aykun Hakgör, Şeyhmus Külahçıoğlu, Ali Karagöz, Nihal Özdemir, Cihangir Kaymaz
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引用次数: 0

Abstract

Background: Intermediate-high-risk (IHR) pulmonary embolism (PE) is defined by right ventricular (RV) dysfunction and elevated cardiac troponin in the absence of hemodynamic instability. While full-dose thrombolysis may improve outcomes, it poses a high bleeding risk. This study assessed the safety and efficacy of a reduced-dose, slow-infusion thrombolytic regimen.

Methods: This single-center retrospective study included 124 patients with acute IHR PE who met at least one of the following criteria: systolic blood pressure ≤110 mm Hg, heart rate >100 bpm, SpO2 <90% on room air, respiratory rate >20/min, or lactate >2 mmol/L. Patients with contraindications to thrombolysis or symptom onset >14 days were excluded. Patients received 25 mg intravenous alteplase (t-PA) infused over 4-6 hours, along with standard anticoagulation according to the institutional protocol. Following the initial dose, a repeat infusion of 25 mg over 4-6 hours was administered if tachycardia, hypoxia, or signs of organ hypoperfusion persisted on re-evaluation.

Results: Syncope was the presenting symptom in 27.4%, and 49.2% had deep vein thrombosis. Median t-PA dose was 50 mg and median infusion duration was 6 hours. Significant improvements were observed in RV and RA size/function, thrombus burden, and clinical parameters (all P < .001). Qanadli score and RV/LV ratio decreased by 55% and 29%, respectively. Major and minor bleeding occurred in 4.8% and 3.2%. In-hospital mortality was 4.8%; 12-month survival was 89.5%. Chronic thromboembolic pulmonary hypertension developed in 3.2%.

Conclusion: Low-dose, slow-infusion t-PA therapy appears effective and well-tolerated, offering hemodynamic and clinical benefit with fewer bleeding complications in patients with IHR PE.

低剂量慢速静脉输注组织型纤溶酶原激活剂治疗急性肺栓塞中高危患者的有效性和安全性
背景:在没有血流动力学不稳定的情况下,中高危(IHR)肺栓塞(PE)被定义为右心室(RV)功能障碍和心肌肌钙蛋白升高。虽然全剂量溶栓可以改善预后,但它会带来较高的出血风险。本研究评估了低剂量、慢速输注溶栓方案的安全性和有效性。方法:这项单中心回顾性研究纳入了124例急性IHR PE患者,他们至少符合以下标准之一:收缩压≤110 mm Hg,心率>100 bpm, SpO2 20/min,或乳酸>2 mmol/L。排除有溶栓禁忌症或症状出现时间小于14天的患者。患者接受25毫克静脉滴注阿替普酶(t-PA)超过4-6小时,并根据机构方案标准抗凝治疗。在初始剂量后,如果重新评估时仍然存在心动过速、缺氧或器官灌注不足的迹象,则重复输注25mg,持续4-6小时。结果:27.4%的患者出现晕厥,49.2%的患者出现深静脉血栓。t-PA中位剂量为50 mg,中位输注时间为6小时。RV和RA的大小/功能、血栓负荷和临床参数均有显著改善(P < 0.001)。Qanadli评分和RV/LV比值分别下降了55%和29%。大出血和轻度出血分别为4.8%和3.2%。住院死亡率为4.8%;12个月生存率为89.5%。慢性血栓栓塞性肺动脉高压发生率为3.2%。结论:低剂量、慢速输注t-PA治疗似乎有效且耐受性良好,为IHR PE患者提供血流动力学和临床益处,并减少出血并发症。
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来源期刊
Anatolian Journal of Cardiology
Anatolian Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.30
自引率
7.70%
发文量
270
审稿时长
12 weeks
期刊介绍: The Anatolian Journal of Cardiology is an international monthly periodical on cardiology published on independent, unbiased, double-blinded and peer-review principles. The journal’s publication language is English. The Anatolian Journal of Cardiology aims to publish qualified and original clinical, experimental and basic research on cardiology at the international level. The journal’s scope also covers editorial comments, reviews of innovations in medical education and practice, case reports, original images, scientific letters, educational articles, letters to the editor, articles on publication ethics, diagnostic puzzles, and issues in social cardiology. The target readership includes academic members, specialists, residents, and general practitioners working in the fields of adult cardiology, pediatric cardiology, cardiovascular surgery and internal medicine.
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