Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso, Texas, TX, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, Health Sciences Center of El Paso, Texas, TX, USA.
Angiology. 2024 Mar;75(3):208-218. doi: 10.1177/00033197231167062. Epub 2023 Apr 15.
Pulmonary embolism (PE) is the third-leading cause of cardiovascular mortality and the second-leading cause of death in cancer patients. The clinical efficacy of thrombolysis for acute PE has been proven, yet the therapeutic window seems narrow, and the optimal dosing for pharmaceutical reperfusion therapy has not been established. Higher doses of systemic thrombolysis inevitably associated with an incremental increase in major bleeding risk. To date, there is no high-quality evidence regarding dosing and infusion rates of thrombolytic agents to treat acute PE. Most clinical trials have focused on thrombolysis compared with anticoagulation alone, but dose-finding studies are lacking. Evidence is now emerging that lower-dose thrombolytic administered through a peripheral vein is efficacious in accelerating thrombolysis in the central pulmonary artery and preventing acute right heart failure, with reduced risk for major bleeding. The present review will systematically summarize the current evidence of low-dose thrombolysis in acute PE.
肺栓塞（PE）是心血管死亡的第三大原因，也是癌症患者死亡的第二大原因。溶栓治疗急性 PE 的临床疗效已得到证实，但治疗窗似乎较窄，尚未确定药物再灌注治疗的最佳剂量。更高剂量的全身溶栓治疗不可避免地与主要出血风险的增加相关。迄今为止，关于溶栓剂治疗急性 PE 的剂量和输注率尚无高质量的证据。大多数临床试验都集中在溶栓治疗与单独抗凝治疗相比，但缺乏剂量探索研究。现在有证据表明，通过外周静脉给予较低剂量的溶栓剂可有效加速中心肺动脉内的溶栓，并预防急性右心衰竭，同时降低大出血风险。本综述将系统总结急性 PE 中低剂量溶栓治疗的现有证据。
