Efficacy and Safety of Low Dose Recombinant Tissue-Type Plasminogen Activator for the Treatment of Acute Pulmonary Thromboembolism

Abstract

clinicaltrials.gov; Identifier: NCT00781378.

Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: scope of the problem

“…This dosing strategy has been shown to be effective but has also demonstrated a high rate of bleeding complications. In addition, fibrinolytics carry a significant dose-dependent risk of bleeding [Wang et al 2010]. Although fixed dosing is standard for the PE indication, weight-based dosing is utilized in the setting of myocardial infarction and ischemic stroke.…”

“…One prospective, randomized, multicenter trial from China evaluated 118 patients with acute PE with evidence of hemodynamic compromise or anatomically massive pulmonary embolism with right ventricular dysfunction [Wang et al 2010]. Patients were randomized to low-dose alteplase at 50 mg/2 hours (n = 65) or 100 mg/2 hours (n = 53) followed by low-molecular-weight heparin.…”

Pulmonary embolism in old age: usefulness of risk stratification in clinical decision-making

“…Several, non-standardized, criteria have been used to diagnose RVD with ECG, such as right-to-left ventricular ratio, right ventricular hypokinesis, and elevated systolic pulmonary artery pressure. 12,13 The only CT criterion for RVD is the right-to-left ventricular ratio. 14 …”

“…Interestingly, in two small studies a strategy using a halveddose of tissue plasminogen activator (rtPA) appeared to be safe compared with anticoagulation alone, while maintaining similar efficacy than usual dose. 12,13 Although these studies did not focus on elderly (mean age 58 and 52 years respectively), their results are appealing for older patients, usually at higher risk of bleeding, and might empirically guide thrombolytic therapy (when deemed appropriate) in these patients. Current guidelines do not recommend thrombolytic therapy in hemodynamically stable patients with PE.…”

Terapia trombolítica en TEP submasivo/riesgo intermedio: Evidencias y sugerencias post estudio Pulmonary Embolism Thrombolysis (PEITHO)

“…En pacientes con peso menor a 65 kg, la dosis total administrada es de 1,5 mg/kg. Dos estudios 53,55 muestran que en TEP submasivo, el usar la mitad de dosis no aumenta el sangrado y con una eficacia superior a la anticoagulación sola y similar respecto de dosis plena. Así, si la trombolisis está indicada, pero existe alto riesgo de sangrado, podría considerarse el uso de media dosis.…”