Department of Radiology, University of Illinois Health, Chicago, Illinois, United States of America.
Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America.
PLoS One. 2019 Feb 6;14(2):e0211701. doi: 10.1371/journal.pone.0211701. eCollection 2019.
The purpose of this study is to assess the incremental effect of tissue plasminogen activator (t-PA) dose on pulmonary artery pressure (PAP) and bleeding during catheter directed thrombolysis (CDT) of submassive pulmonary embolism (PE).
Records of 46 consecutive patients (25 men, 21 women, mean age 55±14 y) who underwent CDT for submassive PE between September 2009 and February 2017 were retrospectively reviewed. Mean t-PA rate was 0.7±0.3 mg/h. PAP was measured at baseline and daily until CDT termination. Mixed-effects regression modeling was performed of repeated PAP measures in individual patients. Bleeding events were classified by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) and t-PA dose at onset.
Mean t-PA dose was 43.0±30.0 mg over 61.9± 28.8 h. Mean systolic PAP decreased from 51.7±15.5 mmHg at baseline to 35.6±12.7 mmHg at CDT termination (p<0.001). Mixed-effects regression revealed a linear decrease in systolic PAP over time (β = -0.37 (SE = 0.05), p<0.001) with reduction in mean systolic PAP to 44.8±1.9 mmHg at 12 mg t-PA/20 h, 39.5±2.0 mmHg at 24 mg t-PA/40 h, and 34.9±2.1 mmHg at 36 mg/60 h. No severe, one moderate, and 8 mild bleeding events occurred; bleeding onset was more frequent at ≤24 mg t-PA (p <0.001). One patient expired from cardiopulmonary arrest after 16 h of CDT (15.4 mg t-PA); no additional intra-procedural fatalities occurred.
Increased total t-PA dose and CDT duration were associated with greater PAP reduction without increased bleeding events.
本研究旨在评估组织型纤溶酶原激活物（t-PA）剂量对亚大块肺栓塞（PE）导管定向溶栓（CDT）过程中肺动脉压（PAP）和出血的增量影响。
回顾性分析了 2009 年 9 月至 2017 年 2 月期间接受 CDT 治疗的 46 例连续患者（25 例男性，21 例女性，平均年龄 55±14 岁）的记录。t-PA 平均速率为 0.7±0.3mg/h。在基线和 CDT 结束前每天测量 PAP。对个体患者的重复 PAP 测量进行混合效应回归建模。出血事件按全球溶栓和组织型纤溶酶原激活剂用于闭塞性冠状动脉（GUSTO）和 t-PA 起始剂量进行分类。
t-PA 总剂量为 43.0±30.0mg，持续时间为 61.9±28.8h。收缩压从基线时的 51.7±15.5mmHg 降至 CDT 结束时的 35.6±12.7mmHg（p<0.001）。混合效应回归显示，收缩压随时间呈线性下降（β=-0.37（SE=0.05），p<0.001），在 12mg t-PA/20h 时，平均收缩压降至 44.8±1.9mmHg，24mg t-PA/40h 时降至 39.5±2.0mmHg，36mg/60h 时降至 34.9±2.1mmHg。无严重出血，1 例中度出血，8 例轻度出血；在≤24mg t-PA 时，出血起始更为频繁（p<0.001）。1 例患者在 CDT 后 16 小时因心肺骤停死亡（t-PA 用量 15.4mg）；无其他术中死亡事件发生。
增加总 t-PA 剂量和 CDT 持续时间与 PAP 降低相关，而不增加出血事件。
