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Long-term results of low-dose tissue plasminogen activator therapy in acute pulmonary embolism
  1. Habibe Hezer1,
  2. Hatice Kiliç2,
  3. Osama Abuzaina2,
  4. H Canan Hasanoǧlu‎2,
  5. Ayşegül Karalezli2
  1. 1 Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
  2. 2 Department of Pulmonary Diseases, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
  1. Correspondence to Dr. Habibe Hezer, Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey; hoflaz{at}


Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality.

In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups.

Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

  • low dose
  • pulmonary embolism
  • thrombolytic therapy
  • tissue plasminogen activator (Rt-PA)

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  • Contributors Only the authors are contributed in this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests HH, HK, OA, CH and AK declares that they have participated in the design, execution and analysis of the paper, and that they have approved the final version.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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