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Low‐dose systemic thrombolytic therapy for treatment of submassive pulmonary embolism: Clinical efficacy but attendant hemorrhagic risks
Author(s) -
Rothschild Daniel P.,
Goldstein James A.,
Bowers Terry R.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28042
Subject(s) - medicine , pulmonary embolism , complication , surgery
Objectives The purpose of the present study is to evaluate the safety and efficacy of “low‐dose” systemic thrombolytic therapy (TT) for treatment of patients with intermediate‐high risk submassive pulmonary embolism (PE). Background TT is increasingly utilized in acute submassive PE. Strategies for TT include catheter‐directed administration as well as traditional IV systemic therapy. Regardless of the route, most studies document the attendant significant bleeding complication rates expected from induction of a systemic lytic state. To mitigate bleeding, “low‐dose” systemic TT (Alteplase 50 mg) has been advocated, based on recent studies which demonstrated clinical efficacy with elimination of any significant bleeding complications. Methods Over a 24‐month period, our institutional PE Response Team treated 45 acute submassive PE patients with “Low Dose” IV Alteplase 50 mg. Clinical outcomes and bleeding complications were assessed. Results Overall clinical outcome was excellent, with 97.8% of patients surviving to discharge and a 30‐day, all‐cause mortality of 4.4%. Despite no patients having a HAS‐BLED score > 2 (average score = 0.8 +/−), ISTH major and GUSTO moderate bleeding was observed in 11% (n = 5) of cases. Conclusions The present observations document that low‐dose systemic TT is associated with excellent clinical outcome for intermediate‐high risk submassive PE, but with attendant risk for bleeding. These findings are consistent with the concept that induction of a therapeutic lytic state carries inextricable bleeding risk.