Key result
Low-dose rt-PA significantly lowers PASP at 24 hours vs. anticoagulation alone in intermediate-risk PE.
Why the study?
The efficacy and safety of initial thrombolysis by recombinant tissue-type plasminogen activator compared with anticoagulant therapy in acute intermediate-risk pulmonary embolism patients was uncertain.
Does low dose rt-PA improve right ventricular parameters and clinical outcomes compared to LMWH in patients with acute intermediate-risk pulmonary embolism?
Comparison
Low dose rt-PA vs LMWH
Design
Randomized controlled open-label trial
Follow-up
90 days
Authors
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Supports low-dose rt-PA for faster RV hemodynamic recovery in intermediate-risk PE; extends RCT evidence beyond standard anticoagulation.
RCT (n=66)
Open-label
Envelope randomization
No
Does low dose rt-PA improve right ventricular parameters and clinical outcomes compared to LMWH in patients with acute intermediate-risk pulmonary embolism?
Absolute Event Rate: 17% vs 4.6%
p-value: p=<0.001
Low-dose rt-PA rapidly improves right ventricular hemodynamics and reduces hemodynamic decompensation compared to LMWH in acute intermediate-risk pulmonary embolism, though it increases minor bleeding.
Zhang et al. (2018) conducted an RCT in Acute intermediate-risk pulmonary embolism (n=66). Recombinant tissue-type plasminogen activator (rt-PA) vs. Low-molecular-weight heparin (LMWH) alone was evaluated on Mean reduction in pulmonary artery systolic pressure (PASP) from baseline to 24 hours (p=<0.001). Low dose recombinant tissue-type plasminogen activator (30 mg) significantly reduced pulmonary artery systolic pressure at 24 hours compared to anticoagulation alone in patients with acute intermediate-risk pulmonary embolism.
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