title: Thrombolysis with a novel modified tissue-type plasminogen activator, monteplase, combined with catheter-based treatment for major pulmonary embolism.
abstract: BACKGROUND
  A novel modified tissue-type plasminogen activator, monteplase, has been approved for acute major pulmonary embolism (PE) in Japan. Monteplase has rapid and sustained lytic effects because of a steep rise in concentration after bolus infusion and a longer half-life.
  
  
  RESULTS
  To assess the efficacy and safety of thrombolysis with monteplase in combination with catheter-based treatment, acute hemodynamic changes and clinical outcomes were assessed in 50 patients with angiographically confirmed major PE. Thrombolysis with monteplase in combination with embolus fragmentation and thrombectomy was the acute phase treatment. The study population comprised 31 females and 19 males (mean age 62 years). All patients had right ventricular (RV) overload; 12 patients presented in shock. The mean pulmonary artery pressure decreased significantly from 32+/-9 mmHg to 25+/-6 mmHg after acute phase treatment (P<0.0001). The mean dosage of monteplase was 12,265 IU/kg. Death at 30 days occurred in 3 patients (6%). Major bleeding occurred in 12 patients (24%). RV overload at discharge remained in only 3% of the patients with typically acute onset.
  
  
  CONCLUSIONS
  Thrombolysis with monteplase, in combination with catheter-based treatment, is an effective and safe therapy for major PE.
authors.affiliation: Intensive and Cardiac Care Unit, Nippon Medical School Hospital, Tokyo, Japan. yamamoto56@nms.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Tokita
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Yu-Ki
authors.initials: YK
authors.lastname: Iwasaki
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tajima
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000628:therapy*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: C468277:monteplase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator