Use of reteplase for thrombolysis in patients with massive pulmonary embolism diagnosed by bedside transthoracic echocardiography: A retrospective study of safety and efficacy

BACKGROUND: Pulmonary embolism (PE) is a lethal clinical condition requiring immediate systemic thrombolysis to decrease mortality. Reteplase has been extensively used in acute myocardial infarction but studies in massive PE are rare. We have presented here efficacy and safety of reteplase in patients with high risk PE diagnosed on basis of bedside transthoracic echocardiography. METHODS: This was retrospective study including 20 patients of massive PE undergoing thrombolysis with reteplase. Bedside TTE was used to evaluate presence of RV dysfunction and thrombi in these patients with hemodynamic compromise. Safety and efficacy outcomes were analysed till three months of follow up. RESULTS: 12 patients (60%) included in the study were males and mean age was 41 ± 19 years. The dyspnoea, chest pain and haemoptysis improved in all patients after thrombolysis. At discharge, RV dilatation normalised, systolic pulmonary artery pressure decreased, systolic blood pressure significantly increased and hypoxemia had completely corrected. Two patients had minor self-limiting bleeding episodes in form of mild haematuria and oral bleeding. During the follow up period of 3 months all patients were clinically stable and there were no bleeding episodes or death. Moreover, there was no recurrence of PE and/or DVT. CONCLUSION: Reteplase is highly efficacious in massive pulmonary embolism and results in rapid clinical improvement. Moreover, it can be safely used without increased risk of significant bleeding or mortality. Although limited by retrospective nature, reteplase appears to be an attractive option for massive PE but large prospective studies are further required.