Outcomes of systemic thrombolysis with reteplase in high-risk acute pulmonary embolism

High-risk pulmonary embolism (PE) is known as the presence of hemodynamic instability and has a high mortality rate, which necessitates immediate reperfusion treatment. According to current PE treatment guidelines, alteplase is the approved and preferred agent for systemic thrombolysis. Herein, we present the efficacy and safety of systemic thrombolysis with reteplase in patients with high-risk PE.

The present retrospective observational study includes 30 patients with high-risk acute PE undergoing systemic thrombolysis with reteplase. All patients were in obstructive shock. The thrombolytic regimen consisted of two bolus doses of 10 U reteplase, given 30 min apart, followed by intravenous heparin.

All patients had elevated cardiac troponin levels. D-dimer levels were elevated in 28 (93.3 %) patients. Systolic blood pressure increased after thrombolysis with reteplase, and the dyspnea, tachypnea, and coughing improved in all patients. Mean SPO₂ was 83.6 ± 6.96 % before treatment, which had risen to 95.7 ± 1.29 % after thrombolysis (p=0.059). Right ventricular dilatation was seen in all patients at presentation, which improved by 96.6 % after treatment and systolic pulmonary artery pressure decreased significantly in all patients at discharge. None of the patients needed to repeat thrombolytic therapy. There were no major hemorrhagic complications or death after thrombolysis, while 5 (16.7 %) patients experienced minor self-limiting bleeding.

Reteplase, as two bolus injections of 10 U given 30 min apart, is an effective thrombolytic regimen in treating acute high-risk PE with a low risk of major hemorrhagic complications.