Key result
Local low-dose urokinase reduces systolic pulmonary artery pressure by ~17 mmHg and improves RV function.
Why the study?
The effectiveness and safety of local low-dose urokinase thrombolysis in haemodynamically stable pulmonary embolism with right ventricular dysfunction were not well established.
Does local low-dose urokinase thrombolysis improve thrombus burden, pulmonary artery pressures, and right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism with right ventricular dysfunction?
Does local low-dose urokinase thrombolysis improve thrombus burden, pulmonary artery pressures, and right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism with right ventricular dysfunction?
Mean Difference: 17.2 (95% CI 14.5–19.9)
p-value: p=<0.0001
Local low-dose urokinase thrombolysis rapidly decreases thrombus burden and pulmonary artery pressures without life-threatening complications in patients with haemodynamically stable pulmonary embolism and right ventricular dysfunction.
LLDUT may support RV recovery in stable PE with RVD; leaves open efficacy and safety versus anticoagulation in randomized trials.
AIMS: The aim of this study was to evaluate the effectiveness of local low-dose urokinase thrombolysis (LLDUT) in haemodynamically stable pulmonary embolism with right ventricular dysfunction (RVD). METHODS AND RESULTS: This was a prospective study. LLDUT with a 200,000 IU bolus followed by a 100,000 IU/hr infusion was given. Treatment duration was determined through radiological control performed 48-72 hrs into treatment. A follow-up echocardiogram was performed within seven days after LLDUT completion. Evolution of thrombus burden, pulmonary artery pressures (PAP) and RVD were studied, and haemorrhagic complications and mortality were recorded. Eighty-seven patients were included (62.5±16.5 years). In 67 patients (77%), the baseline echocardiogram showed mild-to-severe RVD, a dilated right ventricle (diameter: 44.4±6.2 mm) and a decreased tricuspid annular plane systolic excursion (14 mm [12-17]). Seventy-six patients (87.4%) experienced radiological improvement. Initially high PAP (mmHg) decreased after LLDUT: systolic 52.4 vs. 35.2 (17.2 [95% CI: 14.5-19.9]; p<0.0001), mean 34.2 vs. 23.5 (10.7 [95% CI: 9.0-12.5]; p<0.0001) and diastolic 23.9 vs. 16.0 (7.9 [95% CI: 6.1-9.7]; p<0.0001). Follow-up echocardiography showed overall improvement of RVD. No life-threatening haemorrhagic complications were reported. Six-month survival was 96.5%. CONCLUSIONS: LLDUT rapidly decreased thrombus burden and PAP, improving right ventricular function, and was not associated with any life-threatening complications or pulmonary embolism (PE)- or treatment-related mortality.
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Carmona et al. (2018) studied Haemodynamically stable pulmonary embolism with right ventricular dysfunction (n=87). Local low-dose urokinase thrombolysis (LLDUT) was evaluated on Reduction in systolic pulmonary artery pressure (MD 17.2, 95% CI 14.5-19.9, p=<0.0001). Local low-dose urokinase thrombolysis significantly reduced systolic pulmonary artery pressure (mean difference 17.2 mmHg; 95% CI 14.5-19.9; p<0.0001) and improved right ventricular function.
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