Heparin Plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism - Heparin Plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism

Description:

Are thrombolytic agents beneficial in the treatment of hemodynamically stable patients with acute submassive pulmonary embolism?

Study Design

Study Design:

Patients Enrolled: 256

Drug/Procedures Used:

Patients with acute pulmonary embolism and pulmonary hypertension or right ventricular dysfunction without arterial hypotension or shock (n=256) were randomly assigned in a double blind fashion to receive heparin plus 100 mg of alteplase (118) or heparin (138) plus placebo over a period of two hours.

Principal Findings:

Patients with acute pulmonary embolism and pulmonary hypertension or right ventricular dysfunction without arterial hypotension or shock (n=256) were randomly assigned in a double blind fashion to receive heparin plus 100 mg of alteplase (118) or heparin (138) plus placebo over a period of two hours.

Interpretation:

Among hemodynamically stable patients with submassive pulmonary embolism, this trial demonstrates that the use of heparin plus alteplase is associated with improved clinical outcomes. While thrombolysis is currently indicated only in patients with acute pulmonary embolism with hemodynamic instability, this study supports expanding its use for the treatment of patients with acute pulmonary embolism with right ventricular dysfunction and normal systemic arterial pressure. The potential for benefit in such patients results from prevention of future pulmonary hypertension, prevention of recurrence of pulmonary embolism secondary to clot lysis in the pulmonary and deep venous circulation, and rapid improvement in right ventricular function.

References:

Konstantinides S, Geibel A, Heusel G, et al. Heparin Plus Alteplase Compared with Heparin Alone in Patients with Submassive Pulmonary Embolism. N Engl J Med 2002;347:1143-1150.

Clinical Topics: Anticoagulation Management, Dyslipidemia, Heart Failure and Cardiomyopathies, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Lipid Metabolism, Pulmonary Hypertension

Keywords: Thrombolytic Therapy, Arterial Pressure, Pulmonary Embolism, Hypertension, Pulmonary, Heparin, Hypotension, Fibrinolytic Agents, Tissue Plasminogen Activator, Ventricular Dysfunction, Right


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