Investigation of the efficiency and safety of half-dose and full-dose tissue plasminogen activator therapy in pulmonary embolism.

Introduction: The objective of this study was to investigate the impact of two different doses of alteplase, a thrombolytic therapy, specifically half-dose (50 mg) and full-dose (100 mg), on short-term (7 days) and long-term (1 year) mortality and morbidity in the treatment of pulmonary embolism (PE).

Materials and methods: A retrospective cohort study was conducted at the Department of Chest Diseases of Erciyes University Faculty of Medicine Hospital from January 1, 2010 to October 31, 2021. The study enrolled patients diagnosed with PE who underwent treatment with either 50 mg or 100 mg of alteplase. In total, 58 patients participated, with 41 receiving a 50 mg dose of alteplase and 17 receiving a 100 mg dose of alteplase treatment.

Result: Of the patients, 62.1% (n= 36) were female, with a mean age of 63 ± 14.5 years. Mean length of hospital stay was 9.2 ± 7.4 days. Mortality rate of the patients who had PE and received half-dose treatment was 36.5%, and mortality rate of the patients who received full-dose treatment was 17.6%. Mean time to mortality for non-survivors was 126.1 ± 355.4 days. Of the 18 patients who did not survive, 44.4% (n= 8) died within the first seven days, 50% (n= 9) between days eight and 365, and 5.6% (n= 1) after 365 days. In-hospital mortality occurred in 25.9% of the patients (n= 15), with no statistically significant relationship found between mortality status, time to death, in-hospital mortality, vasopressor use, ventilation support requirement, cardiopulmonary resuscitation, and the dose of alteplase treatment (p> 0.05). The comparison of survival rates by the administered alteplase treatment dose revealed no significant relationship (p= 0.187). Notably, there was no in-hospital mortality among the patients under the age of 65 who received a full dose of alteplase treatment, and this result was statistically significant (p= 0.010).

Conclusions: Upon comprehensive evaluation of the data gathered from our study, short-term mortality was significant in favor of the group receiving full dose in patients under 65 years of age. However, it is worth noting that longterm mortality and bleeding rates were comparable in both groups.