[Pulmonary embolism: which thrombolytic should be chosen?].
A consensus has been reached in the last few years on the validity of the indication of thrombolysis in patients with pulmonary embolism and signs of shock. In this situation, the treatment must be rapid and effective and assessed on the haemodynamic results in the initial hours. A randomised, multicentre, double-blind clinical trial has clearly shown the superiority of rtPA at the dose of 100 mg given in 2 hours over high dose prolonged urokinase, the fall in total pulmonary resistances being 36 and 18% (p = 0.0009) respectively at the second hour. With respect to the secondary effects, the risk of serious haemorrhage with rtPA does not seem to be less than that of the first generation thrombolytics, and the data of 22 published studies even shows an increased risk of cerebral haemorrhage with rtPA compared with urokinase (1.6 versus 0.5%). Recent experience has shown that bolus administration of rtPA does not improve either the efficacy or safety of this drug. Therefore rtPA (100 mg in 2 hours) is the drug of choice in patients with a low risk of haemorrhage whereas the elderly patients with low body weight and hypertensives should probably be treated with low dose urokinase given in bolus administration, the efficacy/risk ratio of which seems to be satisfactory.
Pacouret
G
G
Service de cardiologie D et Unité de soins cardiaques Intensifs, CHU Trousseau, Tours.
Augusseau-Richard
M P
MP
Dessenne
X
X
Pagot
O
O
Charbonnier
B
B
D002543:Cerebral Hemorrhage / Q000139:chemically induced; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D011651:Pulmonary Artery / Q000187:drug effects; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000503:physiopathology; D013300:Streptokinase / Q000494:pharmacology / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D014655:Vascular Resistance / Q000187:drug effects
D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator