Key result
Pulmonary intra-arterial thrombolysis with streptokinase significantly increased clinical success (96.4% vs 70.8%) and reduced in-hospital mortality (0% vs 29.2%) compared to systemic administration in patients with high-risk pulmonary embolism.
Why the study?
Does pulmonary intra-arterial thrombolysis with streptokinase improve clinical success and reduce mortality compared to systemic thrombolysis in patients with acute high-risk pulmonary embolism?
RCT (n=52)
Open-label
Randomized
No
Does pulmonary intra-arterial thrombolysis with streptokinase improve clinical success and reduce mortality compared to systemic thrombolysis in patients with acute high-risk pulmonary embolism?
Pulmonary intra-arterial thrombolysis with streptokinase significantly improves clinical success and reduces in-hospital mortality compared to systemic thrombolysis in patients with high-risk pulmonary embolism.
Local thrombolysis may improve outcomes in high-risk PE but should not yet change practice; leaves open need for larger confirmatory trials.
BACKGROUND AND AIM: High-risk pulmonary embolism (PE) represents an important health problem in emergency cardiology, being associated with a high rate of mortality. The aim of this study is to assess the efficacy and safety of pulmonary intra-arterial thrombolysis with streptokinase compared to systemic thrombolysis. METHODS AND RESULTS: In our study, 28 patients with acute high risk PE were treated by intra-arterial thrombolysis with clinical success rate of 96.4%, while in the group with systemic thrombolysis (24 patients) the rate of clinical success was significantly lower (70.8%). Also, pressure gradient between right ventricle (RV) and right atrial (RA) (PRV-RA) decreased significantly in patients treated by pulmonary intra-arterial thrombolysis instead of systemic thrombolysis. Mortality during the hospitalization was 0% in the group with local thrombolysis and 29.2% in the other group, with a significant statistical difference. Major bleeding complications appeared in 14.3% of the patients with local thrombolysis and in 20.8% of the ones treated by systemic thrombolysis, without statistical significance. Moreover, the proportion of minor bleeding was comparable in the two groups of patients. There was no intracranial bleeding. Disseminated intravascular coagulation occurred in 1 patient with systemic thrombolysis. CONCLUSIONS: The rate of clinical success and the regression of RV overload were significantly higher in patients treated by pulmonary intra-arterial thrombolysis. The results regarding the efficiency of the pulmonary intra-arterial thrombolysis in high-risk PE are encouraging, the mortality in these patients being significantly lower than the one for systemic administration of the thrombolytic agent.
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Macovei et al. (2015) conducted an RCT in High-risk pulmonary embolism (n=52). Pulmonary intra-arterial thrombolysis (streptokinase) vs. Systemic thrombolysis (streptokinase) was evaluated on Clinical success (asymptomatic status at end of treatment) (p=0.018). Pulmonary intra-arterial thrombolysis with streptokinase significantly increased clinical success (96.4% vs 70.8%) and reduced in-hospital mortality (0% vs 29.2%) compared to systemic administration in patients with high-risk pulmonary embolism.
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