Tissue plasminogen activator and acute pulmonary embolism

Samuel Z. Goldhaber*, Craig M. Kessler, John Heit, John E. Markis, G. V R K Sharma, Douglas L. Dawley, Michael F. Meyerovitz, Douglas E. Vaughan, J. Anthony Parker, Patricia C. Come, Ducksoo Kim, Andrew P. Selwyn, Joseph Loscalzo, Eugene Braunwald

*Corresponding author for this work

Research output: Contribution to journalReview article

7 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)303-312
Number of pages10
JournalJournal of Cellular Biochemistry
Volume38
Issue number4
DOIs
StatePublished - Dec 1988

Keywords

  • pulmonary angiography
  • pulmonary embolism
  • thrombolysis
  • thrombolytic therapy
  • venous thromboembolism

ASJC Scopus subject areas

  • Biochemistry
  • Molecular Biology
  • Cell Biology

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  • Cite this

    Goldhaber, S. Z., Kessler, C. M., Heit, J., Markis, J. E., Sharma, G. V. R. K., Dawley, D. L., Meyerovitz, M. F., Vaughan, D. E., Parker, J. A., Come, P. C., Kim, D., Selwyn, A. P., Loscalzo, J., & Braunwald, E. (1988). Tissue plasminogen activator and acute pulmonary embolism. Journal of Cellular Biochemistry, 38(4), 303-312. https://doi.org/10.1002/jcb.240380409