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[Pulmonary embolism: which thrombolytic should be chosen?]
G Pacouret1, M P Augusseau-Richard, X Dessenne
1Service de cardiologie D et Unité de soins cardiaques Intensifs, CHU Trousseau, Tours.
Archives Des Maladies Du Coeur Et Des Vaisseaux
|November 1, 1995
Summary
For pulmonary embolism with shock, recombinant tissue plasminogen activator (rtPA) is more effective than urokinase. However, rtPA carries a higher risk of cerebral hemorrhage, suggesting tailored treatment approaches based on patient risk factors.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Thrombolysis is indicated for pulmonary embolism with shock, requiring rapid and effective treatment.
- Hemodynamic outcomes in the initial hours are crucial for assessing treatment efficacy.
Purpose of the Study:
- To compare the efficacy and safety of recombinant tissue plasminogen activator (rtPA) versus urokinase in patients with pulmonary embolism and shock.
- To determine the optimal thrombolytic strategy based on patient characteristics and hemorrhage risk.
Main Methods:
- A randomized, multicenter, double-blind clinical trial was conducted.
- Patients received either rtPA (100 mg over 2 hours) or high-dose prolonged urokinase.
- Secondary effects, including hemorrhage risk, were assessed.
Main Results:
- rtPA demonstrated superior efficacy, significantly reducing total pulmonary resistances compared to urokinase (36% vs 18% fall, p=0.0009).
- rtPA showed a higher risk of serious hemorrhage, including cerebral hemorrhage (1.6% vs 0.5% with urokinase).
- Bolus administration of rtPA did not improve efficacy or safety.
Conclusions:
- rtPA (100 mg over 2 hours) is the preferred treatment for patients with low hemorrhage risk.
- Elderly, low body weight, and hypertensive patients may benefit from low-dose urokinase bolus administration due to a satisfactory efficacy/risk ratio.