title: Six-month echocardiographic study in patients with submassive pulmonary embolism and right ventricle dysfunction: comparison of thrombolysis with heparin.
abstract: BACKGROUND
  The aim of this study was to assess the effect of thrombolysis versus heparin treatment on echocardiographic parameters and clinical outcome, during hospitalization and within the first 180 days after admission, in patients with first episode of submassive pulmonary embolism (SPE) and right ventricle dysfunction (RVD).
  
  
  METHODS
  Consecutive patients (age, 18-75 years) with a first episode of SPE, symptoms onset since no more than 6 hours, normal blood pressure (>100 mm Hg), echocardiographic evidence of RVD and positive lung spiral computed tomography were double-blind randomized: 1 group received 100 mg of alteplase (10-mg bolus, followed by a 90-mg intravenous infusion over a period of 2 hours), while the other group received matching placebo. In addition to alteplase or placebo, both groups received an unfractionated heparin treatment. Echocardiogram was performed at admission, at 24, 48 and 72 hours, at discharge and at 3 and at 6 months after randomization.
  
  
  RESULTS
  Seventy-two patients were included into the study; 37 were assigned to thrombolysis and 35 to placebo. Both groups were well matched with regard to features and clinical presentation. Thrombolysis group showed a significant early improvement of RV function compared with heparin group, and this improvement was observed also during the follow-up (180 days). The same group also showed significant reduction in clinical events during the hospitalization and follow-up.
  
  
  CONCLUSIONS
  Our data suggest that, in hemodynamically stable patients with SPE, thrombolysis shows an earliest reduction of RVD and a more favorable trend in clinical outcome, so, it could merit consideration in SPE.
authors.affiliation: G.F. Ingrassia Hospital, Palermo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Fasullo
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Scalzo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maringhini
authors.forename: Filippo
authors.initials: F
authors.lastname: Ganci
authors.forename: Sergio
authors.initials: S
authors.lastname: Cannizzaro
authors.forename: Ivana
authors.initials: I
authors.lastname: Basile
authors.forename: Debora
authors.initials: D
authors.lastname: Cangemi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Terrazzino
authors.forename: Gaspare
authors.initials: G
authors.lastname: Parrinello
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Sarullo
authors.forename: Roberto
authors.initials: R
authors.lastname: Baglini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paterna
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pasquale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D004311:Double-Blind Method; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D006493:Heparin; D010959:Tissue Plasminogen Activator