Tissue plasminogen activator dose and pulmonary artery pressure reduction in catheter directed thrombolysis of submassive pulmonary embolism.

Abstract

PURPOSE:

The purpose of this study is to assess the incremental effect of tissue plasminogen activator (t-PA) dose on pulmonary artery pressure (PAP) and bleeding during catheter directed thrombolysis (CDT) of submassive pulmonary embolism (PE).

MATERIALS AND METHODS:

Records of 46 consecutive patients (25 men, 21 women, mean age 55±14 y) who underwent CDT for submassive PE between September 2009 and February 2017 were retrospectively reviewed. Mean t-PA rate was 0.7±0.3 mg/h. PAP was measured at baseline and daily until CDT termination. Mixed-effects regression modeling was performed of repeated PAP measures in individual patients. Bleeding events were classified by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) and t-PA dose at onset.

RESULTS:

Mean t-PA dose was 43.0±30.0 mg over 61.9± 28.8 h. Mean systolic PAP decreased from 51.7±15.5 mmHg at baseline to 35.6±12.7 mmHg at CDT termination (p<0.001). Mixed-effects regression revealed a linear decrease in systolic PAP over time (β = -0.37 (SE = 0.05), p<0.001) with reduction in mean systolic PAP to 44.8±1.9 mmHg at 12 mg t-PA/20 h, 39.5±2.0 mmHg at 24 mg t-PA/40 h, and 34.9±2.1 mmHg at 36 mg/60 h. No severe, one moderate, and 8 mild bleeding events occurred; bleeding onset was more frequent at ≤24 mg t-PA (p <0.001). One patient expired from cardiopulmonary arrest after 16 h of CDT (15.4 mg t-PA); no additional intra-procedural fatalities occurred.

CONCLUSION:

Increased total t-PA dose and CDT duration were associated with greater PAP reduction without increased bleeding events.

• Authors: Darshan C Patel, Ron C Gaba, Li Liu, R Peter Lokken
• Journal: PloS one (PLoS One) Vol. 14 Issue 2 Pg. e0211701 ( 2019) ISSN: 1932-6203 [Electronic] United States
• PMID: 30726288 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Blood Pressure (drug effects)
• Catheterization, Peripheral (methods)
• Female
• Fibrinolytic Agents (administration & dosage, therapeutic use)
• Humans
• Male
• Middle Aged
• Pulmonary Artery
• Pulmonary Embolism (drug therapy, therapy)
• Retrospective Studies
• Thrombolytic Therapy (methods)
• Tissue Plasminogen Activator (administration & dosage, therapeutic use)