Low-Dose Systemic Alteplase (tPA) for the Treatment of Pulmonary Embolism.

OBJECTIVE

To review and evaluate the evidence regarding the use of low-dose regimens of alteplase (tPA) for the treatment of pulmonary embolism (PE).

DATA SOURCES

A PubMed search (1966-January 2015) was conducted using the search terms pulmonary embolism, drug therapy, thrombolytic therapy, fibrinolytic agents, and tissue plasminogen activator. Articles were cross-referenced for additional citations.

STUDY SELECTION AND DATA EXTRACTION

Clinical trials and case reports published in the English language assessing the use of low-dose systemic tPA for the treatment of PE were reviewed for inclusion.

DATA SYNTHESIS

tPA is a thrombolytic agent indicated for the treatment of massive and submassive PE. Major bleeding complications of tPA are dose dependent and may occur in up to 6.4% of patients. Clinical trials have demonstrated safety and efficacy of low-dose tPA, particularly showing its benefit in patients with a low body weight (<65 kg) and right-ventricular dysfunction. Furthermore, case reports have safely used lower doses of tPA in patients at higher risk of bleeding, including elderly, pregnant, and surgical patients.

CONCLUSIONS

The available data suggest that low-dose tPA may be a safe and effective treatment option for acute PE, particularly in patients at a high risk of bleeding. More studies are needed to determine the optimal dosing regimen of tPA for PE.