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Half-Dose Recombinant Tissue Plasminogen Activator Treatment in Venous Thromboembolism
  1. H. Canan Hasanoğlu, MD*,
  2. Habibe Hezer, MD†,
  3. Ayşegül Karalezli, MD†,
  4. Emine Argüder, MD†,
  5. Hatice Kiliç, MD†,
  6. Ayşegül Şentürk, MD†,
  7. Mükremin Er, MD†,
  8. Ayşe Nur Soytürk, MD†
  1. From the *Department of Chest Diseases, Faculty of Medicine, Yıldırım Beyazit University, Ankara, Turkey; and †Department of Chest Diseases, Atatürk Training and Research Hospital, Ankara, Turkey.
  1. Received April 5, 2013, and in revised form June 12, 2008.
  2. Accepted for publication September 7, 2013.
  3. Reprints: Emine Argüder, MD, Department of Chest Diseases, Atatürk Training and Research Hospital, Bilkent Street Number 3, Postal code 06800, Ankara, Turkey. E-mail: drgullu2000{at}gmail.com.
  4. The study was presented orally at the 34th Turkish Respiratory Society National Congress (October 2012).
  5. The authors have no conflicts of interest.

Abstract

Introduction Pulmonary embolism (VTE) comes in different degrees of severity from massive pulmonary embolism to nonmassive pulmonary embolism with no symptoms or hypoxia. Thrombolytic therapy is a lifesaver especially for patients who are in the high-risk group. In this study, we aimed at evaluating symptoms and clinical and laboratory findings in patients who had a diagnosis of massive or submassive VTE and treated with 50-mg recombinant tissue plasminogen activator (rt-PA) per hour for various problems as opposed to the standard dose, which is 100 mg every 2 hours.

Materials and Methods Forty-six patients with a diagnosis of massive or submassive VTE who received thrombolytic therapy were evaluated retrospectively. Twenty-three patients who were treated with 50-mg rt-PA per hour were included in the study group. On the other hand, 23 patients who were treated with 100 mg of intravenous infusion of rt-PA every 2 hours were included in the control group. Echocardiographic assessment of the right ventricular size, systolic pulmonary artery pressure (sPAP), oxygen saturation, systemic arterial pressure, and heart rate before the thrombolytic therapy and in the first 24 hours after the administration of therapy were checked and noted in both of the groups.

Results No significant difference was found between the 2 groups with regard to demographic data, Wells scores, type of embolism, average symptom duration, sPAP, and oxygen saturation. Differences in recovery, as inferred from vital symptoms and sPAP measurements, were not significant between the 2 groups.

Conclusions Lower-dose thrombolytic therapy showed similar efficacy versus the standard dose in VTE. Thrombolytic therapy is a life-saving treatment in massive VTE. Furthermore, a harm/benefit analysis may lead to the administration of half-dose therapy in selected cases when it is contraindicated for various reasons.

Key Words
  • half dose rt-PA
  • massive pulmonary embolism
  • thrombolytic therapy

http://dx.doi.org/10.2310/JIM.0000000000000014

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