Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double‐blind, placebo‐controlled randomized trial

• Published in: Journal of thrombosis and haemostasis Vol. 12; no. 4; pp. 459 - 468
• Main Authors: Kline, J. A., Nordenholz, K. E., Courtney, D. M., Kabrhel, C., Jones, A. E., Rondina, M. T., Diercks, D. B., Klinger, J. R., Hernandez, J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01.04.2014
• Subjects: Adult; Aged; Double-Blind Method; Dyspnea - complications; Female; Fibrinolytic Agents - therapeutic use; Hemorrhage - complications; Humans; Male; Middle Aged; Probability; Prospective Studies; pulmonary embolism; Pulmonary Embolism - drug therapy; Pulmonary Embolism - mortality; Quality of Life; randomized controlled trial; Shock - complications; thrombolytic therapy; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; ventricular function, right; thrombolytic therapy; pulmonary embolism; quality of life; ventricular function, right; randomized controlled trial
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.12521

Summary Background Acute pulmonary embolism (PE) can worsen quality of life due to persistent dyspnea or exercise intolerance. Objective Test if tenecteplase increases the probability of a favorable composite patient‐oriented outcome after submassive PE. Methods Normotensive patients with PE and right ventricular (RV) strain (by echocardiography or biomarkers) were enrolled from eight hospitals. All patients received low‐molecular‐weight heparin followed by random assignment to either a single weight‐based bolus of tenecteplase or placebo, administered in a double‐blinded fashion. The primary composite outcome included: (i) death, circulatory shock, intubation or major bleeding within 5 days or (ii) recurrent PE, poor functional capacity (RV dysfunction with either dyspnea at rest or exercise intolerance) or an SF36® Physical Component Summary (PCS) score < 30 at 90‐day follow‐up. Results Eighty‐three patients were randomized; 40 to tenecteplase and 43 to placebo. The trial was terminated prematurely. Within 5 days, adverse outcomes occurred in three placebo‐treated patients (death in one and intubation in two) and one tenecteplase‐treated patient (fatal intracranial hemorrhage). At 90 days, adverse outcomes occurred in 13 unique placebo‐treated patients and five unique tenecteplase‐treated patients Thus, 16 (37%) placebo‐treated and six (15%) tenecteplase‐treated patients had at least one adverse outcome (exact two‐sided P = 0.017). Conclusions Treatment of patients with submassive pulmonary embolism with tenecteplase was associated with increased probability of a favorable composite outcome.