Rosa Alan De la, Murguia Adrian Rojas, Brockman Michael J, Mukherjee Debabrata, Rajachandran Manu, Nickel Nils P
Division of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Cardiovasc Hematol Disord Drug Targets. 2025;25(1):46-53. doi: 10.2174/011871529X349173250119114056.
Pulmonary embolism (PE) is a frequent cause of death. Acute PE may be treated either with full anticoagulation (AC) alone or thrombolytic therapy with systemic tissue-type-plasminogen-activator (tPA) based on risk assessment. Currently, AC is the standard of care for most patients with intermediate-high-risk PE, with low-dose tPA emerging as an effective alternative. However, studies directly comparing the efficacy and safety of low-dose tPA to AC are lacking in this patient population.
The aim of this study was to retrospectively compare the efficacy and safety of low-dose tPA, compared to AC alone in regards to right ventricular function, in-hospital mortality and bleeding complications in patients presenting with intermediate-high risk PE.
This is a single-center, retrospective cohort trial conducted at a university hospital. A total of 148 patients were screened, and 88 patients qualified for this study. The primary endpoints were changes in right ventricular function on echocardiogram in 24 hours, in-hospital mortality, and major bleeding complications.
Eighty-eight consecutive patients with intermediate high-risk PE were included. Twenty- six patients (29.5%) received low-dose systemic tPA administered via intravenous infusion, and 62 patients (70.4%) received standard full-dose anticoagulation. There were no significant differences in baseline vital signs or PESI scores between the low-dose tPA and the AC group. Patients in the low-dose tPA group had worse RV function and higher troponin levels at baseline but showed significant improvement in all RV parameters assessed during the 24-hour follow-up. In comparison, there was no significant improvement in RV function in the AC group. There were more bleeding events in the AC group. LOS was shorter in the low-dose tPA group.
Treatment with low-dose prolonged infusion of tPA may be an effective and safe therapy in patients with intermediate-risk PE. Compared to AC, low-dose tPA was effective in decreasing PASP and restoration of RV function.
肺栓塞（PE）是常见的死亡原因。急性PE可根据风险评估单独采用充分抗凝（AC）治疗或使用全身性组织型纤溶酶原激活剂（tPA）进行溶栓治疗。目前，AC是大多数中高危PE患者的标准治疗方法，低剂量tPA正成为一种有效的替代方法。然而，在这一患者群体中，缺乏直接比较低剂量tPA与AC疗效和安全性的研究。
本研究的目的是回顾性比较低剂量tPA与单独AC在中高危PE患者右心室功能、住院死亡率和出血并发症方面的疗效和安全性。
这是一项在大学医院进行的单中心回顾性队列试验。共筛选了148例患者，88例患者符合本研究条件。主要终点是24小时内心脏超声检查右心室功能的变化、住院死亡率和主要出血并发症。
纳入了88例连续的中高危PE患者。26例患者（29.5%）接受了通过静脉输注给予的低剂量全身性tPA，62例患者（70.4%）接受了标准全剂量抗凝治疗。低剂量tPA组和AC组之间的基线生命体征或肺栓塞严重程度指数（PESI）评分无显著差异。低剂量tPA组患者基线时右心室功能较差且肌钙蛋白水平较高，但在24小时随访期间评估的所有右心室参数均有显著改善。相比之下，AC组右心室功能无显著改善。AC组出血事件更多。低剂量tPA组住院时间更短。
低剂量长时间输注tPA治疗可能是中危PE患者的一种有效且安全的治疗方法。与AC相比，低剂量tPA可有效降低肺动脉收缩压（PASP）并恢复右心室功能。
