Key result
Low-dose alteplase linked to ~6% lower in-hospital mortality vs anticoagulation alone in intermediate-high-risk PE.
Why the study?
Does intravenous low-dose alteplase reduce in-hospital mortality in patients with acute intermediate-high-risk pulmonary embolism?
Cohort (n=128)
No
Does intravenous low-dose alteplase reduce in-hospital mortality in patients with acute intermediate-high-risk pulmonary embolism?
Absolute Event Rate: 0% vs 5.5%
p-value: p=0.048
Low-dose alteplase may safely reduce in-hospital mortality and hemodynamic decompensation in intermediate-high-risk pulmonary embolism without increasing the risk of major bleeding compared to anticoagulation alone.
May support low-dose alteplase consideration in intermediate-high-risk PE; hypothesis-generating and leaves open need for randomized confirmation.
Introduction: Patients with acute medium-high risk pulmonary embolism (PE) may experience cardiovascular decompensation and sudden death. Our aim was to evaluate the impact of intravenous low-dose thrombolytic therapy on in-hospital mortality and intracranial bleeding in intermediate-high-risk PE. Materials and Methods: This single-centre, retrospective study included 128 patients with acute intermediate-high-risk PE. Patients were classified into two groups: Low-dose thrombolytic (0.6 mg/kg, maximum 50 mg, alteplase plus parenteral anticoagulant) group and anticoagulant (unfractionated and/or low molecular weight heparin) group. We compared in-hospital mortality, improvement in right ventricular (RV) failure, and haemorrhagic complications between the groups. Result: Fifty-six patients received low-dose recombinant tissue-type plasminogen activator, and 72 patients were treated with anticoagulants. Patients in the low dose thrombolytic group were younger than the anticoagulant group (63.5 ± 15.5 vs. 70.3 ± 15.5; p= 0.016). There were no significant differences in baseline clinical, laboratory, and echocardiographic findings between the groups. Hemodynamic decompensation was significantly lower in the lowdose alteplase group than the anticoagulants group [1.8% vs. 11.1%; OR: 0.145, (95% CI: 0.018-1.2); p= 0.041]. In-hospital mortality rate was 5.5% in the anticoagulant group, and no death was seen in the low-dose thrombolysis group (p= 0.048). Low-dose alteplase significantly improved RV dysfunction compared with anticoagulants [76.8% vs. 40.3%, OR: 4.9 (95% CI: 2.25- 10.68), p< 0.001]. No intracranial hemorrhage was seen, and the incidence of extracranial major bleeding was similar between treatment groups [1.8% vs. 1.4%, OR: 1.29 (95% CI: 0.08-2.1); p= 0.857]. Conclusions: Among the patients with acute intermediate-high-risk PE, low dose alteplase may be preferred safely without increasing the risk of major bleeding and reduced in-hospital mortality compared to heparin.
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YÜKSEL et al. (2025) conducted a cohort in Acute intermediate-high-risk pulmonary embolism (n=128). Low-dose alteplase vs. Anticoagulant alone (unfractionated and/or low molecular weight heparin) was evaluated on All-cause in-hospital mortality (p=0.048). Low-dose alteplase significantly reduced in-hospital mortality compared to anticoagulation alone (0% vs 5.5%, p=0.048) in patients with acute intermediate-high-risk pulmonary embolism.
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