Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study

• Published in: Clinical and experimental emergency medicine Vol. 10; no. 3; pp. 280 - 286
• Main Authors: Aykan, Ahmet Çağrı, Gökdeniz, Tayyar, Gül, İlker, Kalaycıoğlu, Ezgi, Karabay, Can Yücel, Boyacı, Faruk, Hatem, Engin, Weingart, Scott D, Dursun, İhsan
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Emergency Medicine 01.09.2023
• Subjects: echocardiography; low-dose tissue plasminogen activator; Original; pulmonary embolism; thrombolytic therapy; Pulmonary embolism; tPA; low dose; echocardiography; thrombolytic
• ISSN: 2383-4625; 2383-4625
• DOI: 10.15441/ceem.23.015

Severe Pulmonary embolism (PE) has a high mortality, which may be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications including life- threatening bleeding. The aim of this study was to explore the efficacy and safety of low-dose, prolonged administration of tissue-type-plasminogen-activator (tPA) on in-hospital mortality and outcomes in massive PE. This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. Twenty-five mg of tPA was administered over 6 hours by peripheral intravenous infusion. The primary endpoints consisted of in-hospital mortality, major complications, pulmonary hypertension and right ventricular dysfunction. Secondary endpoints 6-month mortality, pulmonary hypertension and right ventricular dysfunction at 6 months. The mean age of the patients was 68.76±14.54. The mean pulmonary artery systolic pressure (PASP) (56.51±7.34 mmHg vs. 34.16±2.81 mmHg, p<0.001), and right/left ventricle (RV/LV) diameter (1.37±0.12vs 0.99±0.12, p<0.001) were significantly decreased after the TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, p<0.001), MPI/Tei index (0.47±0.08 vs 0.55±0.07, p<0.001), Systolic Wave Prime (9.6±2.8 vs 15.3±2.6) were significantly increased after TT. No major bleeding nor stroke was observed. There was one in-hospital death and two additional deaths within 6 months. No cases of pulmonary hypertension were identified during follow up. Results of this pilot study suggest that low-dose prolonged infusion of tPA is an effective and safe therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoration of RV function.