The effect of intravenous low-dose thrombolytics on in-hospital mortality in patients with intermediate-high-risk pulmonary embolism.

INTRODUCTION

Patients with acute medium-high risk pulmonary embolism (PE) may experience cardiovascular decompensation and sudden death. Our aim was to evaluate the impact of intravenous low-dose thrombolytic therapy on in-hospital mortality and intracranial bleeding in intermediate-high-risk PE.

MATERIALS AND

METHODS

This single-centre, retrospective study included 128 patients with acute intermediate-high-risk PE. Patients were classified into two groups: Low-dose thrombolytic (0.6 mg/kg, maximum 50 mg, alteplase plus parenteral anticoagulant) group and anticoagulant (unfractionated and/or low molecular weight heparin) group. We compared in-hospital mortality, improvement in right ventricular (RV) failure, and haemorrhagic complications between the groups.

RESULT: Fifty-six patients received low-dose recombinant tissue-type plasminogen activator, and 72 patients were treated with anticoagulants. Patients in the low dose thrombolytic group were younger than the anticoagulant group (63.5 ± 15.5 vs. 70.3 ± 15.5; p= 0.016). There were no significant differences in baseline clinical, laboratory, and echocardiographic findings between the groups. Hemodynamic decompensation was significantly lower in the lowdose alteplase group than the anticoagulants group [1.8% vs. 11.1%; OR: 0.145, (95% CI: 0.018-1.2); p= 0.041]. In-hospital mortality rate was 5.5% in the anticoagulant group, and no death was seen in the low-dose thrombolysis group (p= 0.048). Low-dose alteplase significantly improved RV dysfunction compared with anticoagulants [76.8% vs. 40.3%, OR: 4.9 (95% CI: 2.25- 10.68), p< 0.001]. No intracranial hemorrhage was seen, and the incidence of extracranial major bleeding was similar between treatment groups [1.8% vs. 1.4%, OR: 1.29 (95% CI: 0.08-2.1); p= 0.857].

CONCLUSIONS

Among the patients with acute intermediate-high-risk PE, low dose alteplase may be preferred safely without increasing the risk of major bleeding and reduced in-hospital mortality compared to heparin.