Goldhaber S Z
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston 12005.
Chest. 1989 May;95(5 Suppl):282S-289S. doi: 10.1378/chest.95.5_supplement.282s.
The use of thrombolytic therapy to treat AMI has reawakened interest in thrombolysis for acute pulmonary embolism (PE). We have investigated the use of recombinant human tissue-type plasminogen activator (rtPA) in patients with acute PE. In an open label study, rtPA achieved more than 90% efficacy and safety. In a trial comparing rtPA with an FDA-approved dose of urokinase (UK), rtPA appeared more rapid and safer. We are now conducting a comparative trial of rtPA with a novel dosing regimen of UK. In addition, a concurrent trial is comparing rtPA vs heparin for improvement in right ventricular function, assessed by echocardiography, among PE patients. However, the greatest challenge in PE research is to undertake a large-scale trial that compares thrombolysis and heparin for reduction of clinically relevant end points such as mortality and recurrent PE.
使用溶栓疗法治疗急性心肌梗死（AMI）重新唤起了人们对急性肺栓塞（PE）溶栓治疗的兴趣。我们已经研究了重组人组织型纤溶酶原激活剂（rtPA）在急性PE患者中的应用。在一项开放标签研究中，rtPA显示出超过90%的疗效和安全性。在一项将rtPA与美国食品药品监督管理局（FDA）批准剂量的尿激酶（UK）进行比较的试验中，rtPA似乎起效更快且更安全。我们目前正在进行一项rtPA与新型给药方案UK的对比试验。此外，一项同期试验正在比较rtPA与肝素对PE患者右心室功能改善的效果，通过超声心动图进行评估。然而，PE研究中最大的挑战是开展一项大规模试验，比较溶栓治疗和肝素治疗在降低死亡率和复发性PE等临床相关终点方面的效果。
