Reduced-Dose Tenecteplase in High-Risk Pulmonary Embolism

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.