Extended infusion of rtPA lysis of pulmonary emboli: influence of time after onset of symptoms on outcome.
OBJECTIVE
Evaluate efficacy and safety of short-term thrombolysis with recombinant human-tissue plasminogen activator (rtPA).


METHODS
Thrombolysis with rtPA was performed in 29 patients with angiographically documented severe acute pulmonary embolism (Miller score of 20/34 or more). All patients received 100 mg rtPA through peripheral veins within the first 2 hr, followed by a continuous infusion of rtPA (0.05 mg/kg/hr) over a 4-hr period. Concomitant intravenous heparin 1000 U/hr infusion was applicated for the first 6 hr.


RESULTS
Using this treatment, 83% of our patients showed clinical improvement objectified by the Miller score, by the clinical stage (Grosser), and by the pulmonary artery mean pressure (PAPm). The treatment regimen was unsuccessful if the clinical history lasted more than 3 days. Complications occurred in 10 patients (34%), and 3 patients (10%) died of acute right heart failure.


CONCLUSIONS
The success of rtPA treatment appears to depend on the interval between onset of symptoms and start of thrombolytic therapy. Otherwise the technique leads to objectifiable improvement within 6 hr with an acceptable bleeding risk.
Aschauer
M
M
Department of Radiology, University Hospital, Graz, Austria.
Pilger
E
E
Szolar
D H
DH
Flueckiger
F
F
Hausegger
K
K
Stark
G
G
Groell
R
R
Klein
G E
GE
Schreyer
H
H
D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator