Half Dose Alteplase or Low Molecular Weight Heparin in Pulmonary Embolism with Intermediate-High risk: Real life Study at Tertiary Hospital

Abstract Background and Aim: Using thrombolytics in intermediate-high risk pulmonary embolism (PE) patients or not is a controversial issue. This study aimed to evaluate the efficacy and complications of half-dose alteplase and low molecular weight heparin (LMWH) administration in PE patients with intermediate-high risk. Material and Methods: The patients diagnosed with intermediate-high risk PE at Ege University Medical Faculty Hospital between 01.01.2016 – 13.02.2023 were included in the study. The patients diagnosed with PE after the establishment of Ege Pulmonary Embolism Team (EGEPET) (2.10.2018) formed the prospective part with the thrombolytic group. The retrospective part-anticoagulation group- included the cases treated with LMWH before EGEPET. Two treatment groups were compared in terms of the one-month mortality and the one-year mortality as primary outcomes. Results: No difference was found regarding the age, comorbidities and vital findings between thrombolytic group and anticoagulation group. Only, the pulse value was higher in the thrombolytic group (p=0,032). After the treatment, the PaO₂/FiO₂ ratio increased significantly, and the pulse rate decreased significantly in the thrombolytic group. Improvement was only seen in the pulse rate in the anticoagulation group. There was no major bleeding in both groups. One-month mortality in thrombolytic group was found in 4 patients (6.7%), while that was observed in 6 patients (15.8%) treated with LMWH (p=0,18). One-year mortality rates were 13.7% and 26.3% respectively (p=0,17). Conclusion: PaO₂/FiO₂ ratio improved significantly and rapidly in patients treated with thrombolysis. Even one-month and one-year mortality rates were reduced in thrombolytic group, but this difference was not found statistically significant.