Al-Terki Hani, Gotzmann Michael, Mahfoud Felix, Lauder Lucas, Mügge Andreas
Cardiology and Rhythmology Department, University Hospital St. Josef Hospital-Bochum, Ruhr University-Bochum, Gudrunstraße 56, 44791 Bochum, Germany.
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes, Saarland University, 66421 Homburg, Germany.
J Clin Med. 2023 Jun 12;12(12):4006. doi: 10.3390/jcm12124006.
Ultrasound-accelerated thrombolysis (USAT) is a safe and effective treatment for patients with intermediate-high-risk pulmonary embolism (PE). In all studies investigating USAT in the setting of PE, the recombinant tissue-plasminogen activator (rt-PA) alteplase or actilyse was used. Currently, there is a shortage of alteplase (Alteplase, Boehringer Ingelheim) in Europe. It is unknown whether the efficacy of urokinase (UK) is comparable with alteplase for USAT in patients with PE.
Patients with intermediate-high-risk PE undergoing USAT with urokinase and alteplase were included in this study. One-to-one nearest neighbour matching was performed to account for baseline differences. We identified one patient treated with USAT and UK ( = 9) for each patient treated with USAT and alteplase ( = 9).
A total of 56 patients underwent USAT. The treatment was successful in all patients. The propensity score matched the identified nine pairs of patients. There were no statistically significant differences in the change in right ventricle-to-left ventricle (RV/LV) ratio (0.4 ± 0.3 versus 0.5 ± 0.4, = 0.54), systolic pulmonary artery pressure (17.3 ± 8.0 versus 18.1 ± 8.1, = 0.17), or improvement of RV function (5.8 ± 3.8 versus 5.1 ± 2.6, = 1.0). The complication rates were comparable (11% in both groups, = 0.55). There were no deaths in hospital or during 90 days in either group.
In this case-matched comparison, the short-term clinical and echocardiographic outcomes showed comparable results between USAT-UK and USAT-rt-PA.
超声加速溶栓（USAT）是治疗中高危肺栓塞（PE）患者的一种安全有效的方法。在所有研究PE患者USAT的研究中，均使用重组组织型纤溶酶原激活剂（rt-PA）阿替普酶或爱通立。目前，欧洲阿替普酶（阿替普酶，勃林格殷格翰）短缺。尚不清楚尿激酶（UK）对PE患者USAT的疗效是否与阿替普酶相当。
本研究纳入接受尿激酶和阿替普酶USAT治疗的中高危PE患者。采用一对一最近邻匹配法以消除基线差异。我们为每位接受USAT和阿替普酶治疗的患者（n = 9）确定了一位接受USAT和UK治疗的患者（n = 9）。
共有56例患者接受了USAT治疗。所有患者治疗均成功。倾向得分匹配确定了9对患者。右心室与左心室（RV/LV）比值变化（0.4±0.3对0.5±0.4，P = 0.54）、收缩期肺动脉压（17.3±8.0对18.1±8.1，P = 0.17）或RV功能改善（5.8±3.8对5.1±2.6，P = 1.0）方面无统计学显著差异。并发症发生率相当（两组均为11%，P = 0.55）。两组均无住院期间或90天内死亡病例。
在这种病例匹配比较中，USAT-UK组和USAT-rt-PA组的短期临床和超声心动图结果显示相似。
