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
{"title":"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","authors":"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","doi":"10.14744/AnatolJCardiol.2025.5524","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":7835,"journal":{"name":"Anatolian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"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\",\"doi\":\"10.14744/AnatolJCardiol.2025.5524\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":7835,\"journal\":{\"name\":\"Anatolian Journal of Cardiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anatolian Journal of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.14744/AnatolJCardiol.2025.5524\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anatolian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.14744/AnatolJCardiol.2025.5524","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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.
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.
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.