Nishanth K R, Math Ravi S, Shankar Mythri, Ravindranath K S, Manjunath C N
Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India.
Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, India.
Indian Heart J. 2019 Nov-Dec;71(6):464-467. doi: 10.1016/j.ihj.2019.09.011. Epub 2019 Sep 20.
Reteplase (recombinant plasminogen activator) is a mutant of alteplase. It has a longer half-life than its parent molecule and has shown better vessel patency rates in acute myocardial infarction. In this study, we analyzed the efficacy and safety of reteplase in acute pulmonary embolism (PE).
This observational study included patients with high- and intermediate-risk acute PE, presenting within 14 days of symptom onset. The patients were treated with reteplase, which was given in two bolus doses of 10 U each, 30 min apart, along with intravenous heparin. Patients with hemodynamic compromise (high-risk or massive PE) and normotensive patients with evidence of right ventricular (RV) dysfunction (intermediate-risk or submassive PE) on echocardiography or computed tomography were included in the study. The efficacy outcomes assessed were in-hospital death and improvement of RV function by echocardiography. The safety outcomes were major bleeding, minor bleeding, and ischemic or hemorrhagic stroke during hospitalization.
Of the 40 patients included, 25% were classified as high risk with hemodynamic compromise and 75% were classified as intermediate risk. RV dysfunction was present in all the patients (100%). Concomitant lower extremity deep vein thrombosis was present in 55% of the patients. The mortality rate was 5%. There was significant improvement in RV function and reduction in pulmonary artery systolic pressure and tricuspid regurgitation severity. There was no major bleeding event or stroke, and 7.5% patients had minor extracranial bleeding.
Double-bolus reteplase given with heparin is effective in the treatment of high- and intermediate-risk PE, with minimal risk of bleeding.
瑞替普酶（重组纤溶酶原激活剂）是阿替普酶的一种突变体。它的半衰期比其母体分子更长，并且在急性心肌梗死中显示出更好的血管通畅率。在本研究中，我们分析了瑞替普酶治疗急性肺栓塞（PE）的疗效和安全性。
这项观察性研究纳入了症状发作14天内就诊的高危和中危急性PE患者。患者接受瑞替普酶治疗，分两次推注给药，每次10 U，间隔30分钟，同时给予静脉肝素。纳入研究的患者包括血流动力学不稳定（高危或大面积PE）的患者以及超声心动图或计算机断层扫描显示有右心室（RV）功能障碍证据（中危或次大面积PE）的血压正常患者。评估的疗效指标为住院期间死亡和超声心动图显示的RV功能改善。安全性指标为住院期间的大出血、小出血以及缺血性或出血性卒中。
纳入的40例患者中，25%被归类为伴有血流动力学不稳定的高危患者，75%被归类为中危患者。所有患者（100%）均存在RV功能障碍。55%的患者同时存在下肢深静脉血栓形成。死亡率为5%。RV功能有显著改善，肺动脉收缩压和三尖瓣反流严重程度降低。未发生大出血事件或卒中，7.5%的患者出现轻微的颅外出血。
瑞替普酶与肝素联合双推注给药治疗高危和中危PE有效，出血风险极小。
