title: [Safe dose rTPA for massive pulmonary embolism associated with high bleeding risk: a case report and review of the literature].
abstract: Systemic thrombolysis is a well known treatment for massive pulmonary embolism (PE) but it remains often underutilized in clinical practice because of the risk of major bleeding, especially intracranial hemorrhage. Recently, the use of safe-dose recombinant tissue-type plasminogen activator (rTPA) has been proposed for the treatment of moderate PE demonstrating to be safe and more effective than standard anticoagulation. We report the case of an 83-year-old male patient affected by massive PE associated with high bleeding risk, and treated with half-dose of rTPA that resulted in rapid clinical improvement. This clinical experience led us to focus on the role of reduced doses of rTPA to decrease bleeding risk in patients with PE. We conclude that the new concept of "safe-dose thrombolysis" with rTPA may be considered a reasonable and interesting option in high-bleeding risk patients with massive PE.
authors.forename: Marco
authors.initials: M
authors.lastname: Mele
authors.forename: Antonietta
authors.initials: A
authors.lastname: Mele
authors.forename: Pietro Paolo
authors.initials: PP
authors.lastname: La Torre
authors.forename: Michele
authors.initials: M
authors.lastname: Cannone
mesh_terms: D000369:Aged, 80 and over; D000747:Anemia, Hypochromic / Q000150:complications; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002037:Bundle-Branch Block / Q000150:complications; D048909:Diabetes Complications / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006474:Hemorrhagic Disorders / Q000139:chemically induced* / Q000209:etiology / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications; D033162:Incidental Findings; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D009765:Obesity / Q000150:complications; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator