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2000
Volume 25, Issue 1
  • ISSN: 1871-529X
  • E-ISSN: 2212-4063

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.

Objectives

The aim of this study was to retrospectively compare the efficacy and safety of low-dose tPA, compared to AC alone in regards to right ventricular function, 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 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.

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2025-02-27
2025-09-01

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Low-dose Systemic Tissue-type-plasminogen-activator Compared to Conventional Anti-coagulation for the Treatment of Intermediate-high Risk Pulmonary Embolism
Cardiovasc Hematol Disord Drug Targets 25, 46 (2025); https://doi.org/10.2174/011871529X349173250119114056
/content/journals/chddt/10.2174/011871529X349173250119114056
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  • Article Type:     Research Article
Keyword(s): anti-coagulation; bleeding complications; pulmonary embolism; right ventricle failure; right ventricle function; Tissue-type-plasminogen-activator

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