Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion.

Abstract

Data from a non-randomised study have hinted that in patients with acute pulmonary embolism (PE), thrombolysis followed by heparin more rapidly reverses right-ventricular dysfunction and restores pulmonary tissue perfusion than does heparin alone. We have pursued this idea in a randomised protocol. 46 haemodynamically stable patients were randomised to recombinant tissue plasminogen activator (alteplase, rt-PA) 100 mg over 2 h followed by intravenous heparin and 55 to heparin alone. Right-ventricular wall motion was assessed qualitatively, and right-ventricular end diastolic area was estimated by planimetry from echocardiograms at baseline and at 3 and 24 hours. Pulmonary perfusion scans were obtained at baseline and 24 hours. In 39% of rt-PA patients but in only 17% of heparin alone patients right-ventricular wall motion at 24 hours had improved from baseline and in 2% and 17%, respectively, it worsened (p = 0.005). rt-PA patients also had a significant decrease in right-ventricular end-diastolic area during the 24 hours after randomisation and a significant absolute improvement in pulmonary perfusion (14.6% vs 1.5%). No clinical episodes of recurrent PE were noted among rt-PA patients, but there were 2 fatal and 3 non-fatal clinically suspected recurrent PEs within 14 days in patients randomised to heparin alone. rt-PA rapidly improves right-ventricular function and pulmonary perfusion among patients with PE and may lead to a lower rate of adverse clinical outcomes.

• Authors: S Z Goldhaber, W D Haire, M L Feldstein, M Miller, R Toltzis, J L Smith, A M Taveira da Silva, P C Come, R T Lee, J A Parker
• Journal: Lancet (London, England) (Lancet) Vol. 341 Issue 8844 Pg. 507-11 (Feb 27 1993) ISSN: 0140-6736 [Print] England
• PMID: 8094768 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Heparin
• Tissue Plasminogen Activator

Topics

• Acute Disease
• Aged
• Echocardiography
• Female
• Heparin (adverse effects, therapeutic use)
• Humans
• Lung (diagnostic imaging)
• Male
• Middle Aged
• Pulmonary Circulation (drug effects)
• Pulmonary Embolism (diagnostic imaging, drug therapy, physiopathology)
• Radionuclide Imaging
• Thrombolytic Therapy
• Tissue Plasminogen Activator (adverse effects, therapeutic use)
• Ventricular Function, Left (drug effects)