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Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism.

Jennifer Hammond1, Dean Cataldo2, Christopher Allison3

  • 1Department of Inpatient Pharmacy, Baystate Medical Center, Springfield, Massachusetts.

The Journal of Emergency Medicine
|February 23, 2025
PubMed
Summary

This case study shows successful treatment of a high-risk pulmonary embolism (PE) in an elderly patient using low-dose tenecteplase and heparin. This approach offers a potential alternative for managing acute PE in hemodynamically compromised individuals.

Keywords:
critical carepulmonary embolismsystemic anticoagulationtenecteplasethrombolytics

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Pulmonology

Background:

  • Pulmonary embolism (PE) is a significant cause of morbidity and mortality, particularly in older adults.
  • Hemodynamically compromised patients with PE typically require thrombolytic therapy in addition to anticoagulation.

Purpose of the Study:

  • To report the successful use of low-dose, systemically administered tenecteplase in an elderly patient with acute, high-risk pulmonary embolism.
  • To highlight a potential treatment strategy for hemodynamically unstable PE patients where reduced-dose tenecteplase may be considered.

Main Methods:

  • A patient over 90 years old with high-risk PE received a reduced dose of tenecteplase (17.5 mg) followed by unfractionated heparin.
  • Norepinephrine was used for initial hemodynamic support and gradually weaned post-thrombolysis.
  • The patient was monitored in the medical intensive care unit.

Main Results:

  • The patient showed significant improvement in hemodynamic status, with norepinephrine requirements resolving within 15 hours post-tenecteplase.
  • No clinically significant bleeding complications were observed.
  • The patient was discharged on hospital day 7 to an acute rehabilitation facility.

Conclusions:

  • Low-dose tenecteplase followed by anticoagulation can be a safe and effective treatment for acute, high-risk pulmonary embolism in elderly, hemodynamically compromised patients.
  • This case suggests a potential role for reduced-dose tenecteplase in PE management, addressing a gap in current literature.
  • Further research is warranted to establish optimal dosing and efficacy of tenecteplase in PE.