Tissue plasminogen activator and acute pulmonary embolism

Area of Science:

• Cardiology
• Pulmonology
• Pharmacology

Background:

• Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
• Effective treatment strategies for PE are crucial for improving patient outcomes.
• Recombinant human tissue-type plasminogen activator (rt-PA) is a thrombolytic agent with potential for PE treatment.

Purpose of the Study:

• To assess the efficacy and safety of peripheral intravenous rt-PA in patients with PE.
• To evaluate the impact of rt-PA on pulmonary artery pressure, lung perfusion, and right ventricular function.
• To investigate the effects of rt-PA on fibrinogen levels and fibrinolysis.

Main Methods:

• A study involving 47 patients with angiographically documented PE.
• Administration of peripheral intravenous rt-PA (50 mg/2 h, with an optional additional 40 mg/4 h).
• Assessment of angiographic clot lysis, pulmonary artery pressure, lung scan perfusion defects, and right ventricular function pre- and post-treatment.

Main Results:

• 94% of patients showed angiographic evidence of clot lysis within 6 hours.
• Significant reduction in pulmonary artery pressure (P < 0.0001) and lung perfusion defects (P < 0.01).
• Improvement in right ventricular function and diameter, with normalization or improvement in wall movement.

Conclusions:

• Peripheral intravenous rt-PA is effective in achieving rapid clot lysis in PE.
• rt-PA treatment leads to significant improvements in pulmonary hemodynamics and right ventricular function.
• The study highlights the potential of rt-PA as a therapeutic option for selected PE patients.