TY - JOUR
T1 - Tissue plasminogen activator and acute pulmonary embolism
AU - Goldhaber, Samuel Z.
AU - Kessler, Craig M.
AU - Heit, John
AU - Markis, John E.
AU - Sharma, G. V R K
AU - Dawley, Douglas L.
AU - Meyerovitz, Michael F.
AU - Vaughan, Douglas E.
AU - Parker, J. Anthony
AU - Come, Patricia C.
AU - Kim, Ducksoo
AU - Selwyn, Andrew P.
AU - Loscalzo, Joseph
AU - Braunwald, Eugene
PY - 1988/12
Y1 - 1988/12
N2 - We assessed the efficacy and safety of peripheral intravenous recombinant human tissue‐type plasminogen activator (rt‐PA) in 47 patients with angiographically documented pulmonary embolism (PE). We administered 50 mg/2 h and, if necessary, an additional 40 mg/4 h. By 6 hours, 94% of the patients had angiographic evidence of clot lysis that was slight in 5, moderate in 12, and marked in 27 patients. Among the 34 patients with pulmonary hypertension prior to treatment, average pulmonary artery pressure decreased from 43/17 (27) to 31/13 (19) mm Hg (P < 0.0001). The average lung scan perfusion defect decreased from 37% before therapy to 16% (P < 0.01) after therapy among the 19 patients who had pre‐ and post‐treatment lung scans. Of 7 patients with pre‐ and post‐treatment imaging and Doppler echocardiograms, hypokinetic right ventricular wall movement (mild in 1, moderate in 2, and severe in 4) normalized in 5 and improved to mild hypokinesis in 2. Right ventricular diameter decreased from 3.9 ± 1.0 to 2.0 ± 0.5 cm (P < 0.005). Fibrinogen decreased 33% from baseline at 2 h and 42% from baseline at 6 h. However, patients with the greatest degree of angiographic clot lysis at 2 h had a preponderance of fibrinogenolysis over fibrinolysis, demonstrated by a lower ratio of cross‐linked fibrin degradation products to fibrin(ogen) degradation products (0.14 ± 0.09 vs. 0.54 ± 0.82) (P < 0.04). Among selected patients, peripheral intravenous rt‐PA is associated with rapid lysis of PE, improved pulmonary perfusion, and improved right ventricular function.
AB - We assessed the efficacy and safety of peripheral intravenous recombinant human tissue‐type plasminogen activator (rt‐PA) in 47 patients with angiographically documented pulmonary embolism (PE). We administered 50 mg/2 h and, if necessary, an additional 40 mg/4 h. By 6 hours, 94% of the patients had angiographic evidence of clot lysis that was slight in 5, moderate in 12, and marked in 27 patients. Among the 34 patients with pulmonary hypertension prior to treatment, average pulmonary artery pressure decreased from 43/17 (27) to 31/13 (19) mm Hg (P < 0.0001). The average lung scan perfusion defect decreased from 37% before therapy to 16% (P < 0.01) after therapy among the 19 patients who had pre‐ and post‐treatment lung scans. Of 7 patients with pre‐ and post‐treatment imaging and Doppler echocardiograms, hypokinetic right ventricular wall movement (mild in 1, moderate in 2, and severe in 4) normalized in 5 and improved to mild hypokinesis in 2. Right ventricular diameter decreased from 3.9 ± 1.0 to 2.0 ± 0.5 cm (P < 0.005). Fibrinogen decreased 33% from baseline at 2 h and 42% from baseline at 6 h. However, patients with the greatest degree of angiographic clot lysis at 2 h had a preponderance of fibrinogenolysis over fibrinolysis, demonstrated by a lower ratio of cross‐linked fibrin degradation products to fibrin(ogen) degradation products (0.14 ± 0.09 vs. 0.54 ± 0.82) (P < 0.04). Among selected patients, peripheral intravenous rt‐PA is associated with rapid lysis of PE, improved pulmonary perfusion, and improved right ventricular function.
KW - pulmonary angiography
KW - pulmonary embolism
KW - thrombolysis
KW - thrombolytic therapy
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=0024238969&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0024238969&partnerID=8YFLogxK
U2 - 10.1002/jcb.240380409
DO - 10.1002/jcb.240380409
M3 - Review article
C2 - 3149283
AN - SCOPUS:0024238969
SN - 0730-2312
VL - 38
SP - 303
EP - 312
JO - Journal of Cellular Biochemistry
JF - Journal of Cellular Biochemistry
IS - 4
ER -