title: Low-Dose Systemic Alteplase (tPA) for the Treatment of Pulmonary Embolism.
abstract: OBJECTIVE
  To review and evaluate the evidence regarding the use of low-dose regimens of alteplase (tPA) for the treatment of pulmonary embolism (PE).
  
  
  METHODS
  A PubMed search (1966-January 2015) was conducted using the search terms pulmonary embolism, drug therapy, thrombolytic therapy, fibrinolytic agents, and tissue plasminogen activator. Articles were cross-referenced for additional citations.
  
  
  METHODS
  Clinical trials and case reports published in the English language assessing the use of low-dose systemic tPA for the treatment of PE were reviewed for inclusion.
  
  
  RESULTS
  tPA is a thrombolytic agent indicated for the treatment of massive and submassive PE. Major bleeding complications of tPA are dose dependent and may occur in up to 6.4% of patients. Clinical trials have demonstrated safety and efficacy of low-dose tPA, particularly showing its benefit in patients with a low body weight (<65 kg) and right-ventricular dysfunction. Furthermore, case reports have safely used lower doses of tPA in patients at higher risk of bleeding, including elderly, pregnant, and surgical patients.
  
  
  CONCLUSIONS
  The available data suggest that low-dose tPA may be a safe and effective treatment option for acute PE, particularly in patients at a high risk of bleeding. More studies are needed to determine the optimal dosing regimen of tPA for PE.
authors: Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA St Joseph's Regional Medical Center, Paterson, NJ, USA gathersk@sjhmc.org.
authors: Kimberly
authors: K
authors: Brandt
authors: Auburn University, Harrison School of Pharmacy, Mobile, AL, USA University of South Alabama Medical Center, Mobile, AL, USA.
authors: Kaitlin
authors: K
authors: McGinn
authors: West Virginia University Healthcare, Morgantown, WV, USA.
authors: Jeffrey
authors: J
authors: Quedado
mesh_terms: D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012306:Risk; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: pulmonary embolism; thrombolytic therapy; tissue plasminogen activator