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

OBJECTIVE: Severe pulmonary embolism (PE) has a high mortality rate, which can 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 extended, low-dos...

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Autores principales: Aykan, Ahmet Çağrı, Gökdeniz, Tayyar, Gül, İlker, Kalaycıoğlu, Ezgi, Karabay, Can Yücel, Boyacı, Faruk, Hatem, Engin, Weingart, Scott D., Dursun, İhsan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Emergency Medicine 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579734/
https://www.ncbi.nlm.nih.gov/pubmed/37188358
http://dx.doi.org/10.15441/ceem.23.015
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author Aykan, Ahmet Çağrı
Gökdeniz, Tayyar
Gül, İlker
Kalaycıoğlu, Ezgi
Karabay, Can Yücel
Boyacı, Faruk
Hatem, Engin
Weingart, Scott D.
Dursun, İhsan
author_facet Aykan, Ahmet Çağrı
Gökdeniz, Tayyar
Gül, İlker
Kalaycıoğlu, Ezgi
Karabay, Can Yücel
Boyacı, Faruk
Hatem, Engin
Weingart, Scott D.
Dursun, İhsan
author_sort Aykan, Ahmet Çağrı
collection PubMed
description OBJECTIVE: Severe pulmonary embolism (PE) has a high mortality rate, which can 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 extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. METHODS: This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. RESULTS: The mean age of the patients was 68.76±14.54 years. 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 diameter (1.37±0.12 vs. 0.99±0.12, P<0.001) decreased significantly after TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, P<0.001), myocardial performance index (0.47±0.08 vs. 0.55±0.07, P<0.001), and systolic wave prime (9.6±2.8 vs. 15.3±2.6) increased significantly after TT. No major bleeding or 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. CONCLUSION: The results of this pilot study suggest that an extended infusion of low-dose tPA is a safe and effective therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoring right ventricular function. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02029456
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spelling pubmed-105797342023-10-18 Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study Aykan, Ahmet Çağrı Gökdeniz, Tayyar Gül, İlker Kalaycıoğlu, Ezgi Karabay, Can Yücel Boyacı, Faruk Hatem, Engin Weingart, Scott D. Dursun, İhsan Clin Exp Emerg Med Original Article OBJECTIVE: Severe pulmonary embolism (PE) has a high mortality rate, which can 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 extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. METHODS: This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. RESULTS: The mean age of the patients was 68.76±14.54 years. 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 diameter (1.37±0.12 vs. 0.99±0.12, P<0.001) decreased significantly after TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, P<0.001), myocardial performance index (0.47±0.08 vs. 0.55±0.07, P<0.001), and systolic wave prime (9.6±2.8 vs. 15.3±2.6) increased significantly after TT. No major bleeding or 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. CONCLUSION: The results of this pilot study suggest that an extended infusion of low-dose tPA is a safe and effective therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoring right ventricular function. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02029456 The Korean Society of Emergency Medicine 2023-05-15 /pmc/articles/PMC10579734/ /pubmed/37188358 http://dx.doi.org/10.15441/ceem.23.015 Text en Copyright © 2023 The Korean Society of Emergency Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ).
spellingShingle Original Article
Aykan, Ahmet Çağrı
Gökdeniz, Tayyar
Gül, İlker
Kalaycıoğlu, Ezgi
Karabay, Can Yücel
Boyacı, Faruk
Hatem, Engin
Weingart, Scott D.
Dursun, İhsan
Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study
title Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study
title_full Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study
title_fullStr Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study
title_full_unstemmed Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study
title_short Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study
title_sort reduced-dose systemic fibrinolysis in massive pulmonary embolism: a pilot study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579734/
https://www.ncbi.nlm.nih.gov/pubmed/37188358
http://dx.doi.org/10.15441/ceem.23.015
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