INTRAVENOUS AND INTRAPULMONARY RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR IN THE TREATMENT OF ACUTE MASSIVE PULMONARY-EMBOLISM
INTRAVENOUS AND INTRAPULMONARY RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR IN THE TREATMENT OF ACUTE MASSIVE PULMONARY-EMBOLISM
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DOI：
10.1161/01.cir.77.2.353
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发表时间：
1988-02-01
期刊：
影响因子：
37.8
通讯作者：
OLSSON, CG
中科院分区：
文献类型：
--
作者：
VERSTRAETE, M;MILLER, GAH;OLSSON, CG
Eight centers participated in a study in which intrapulmonary and intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) were compared in 34 patients with acute massive pulmonary embolism. All patients received intravenous heparin in a bolus of 5000 IU followed by 1000 IU/hr. After 50 mg rt-PA given over 2 hr the severity of embolism, determined from pulmonary angiograms, declined by 12% in the intrapulmonary drug group (P < .005) and 15% in the intravenous drug group (p < .005); mean pulmonary arterial pressure fell from 31 .+-. 7 to 22 .+-. 6 mm Hg (p < .005) and from 31 .+-. 12 to 21.+-. 9 mm Hg (p < .005) in the respective groups. After a further 50 mg given over 5 hr (22 patients), the angiographically determined severity of embolism had decreased by 38% from baseline in the intrapulmonary drug group and by 38% in the intravenous drug group. The mean pulmonary arterial pressure further declined to 18 .+-. 7 and 12 .+-. 5 mm Hg in the respective groups. Fibrinogen levels dropped to 48% of baseline after 50 mg and to 36% of baseline after 100 mg rt-PA. Some degree of bleeding at puncture and/or operation site was noted in 16 patients, including four who required a transfusion of two or more units of blood and had been operated on an average of 7.5 days (range 2 to 13) before thrombolytic treatment was started. In seven other patients thrombolytic treatment was initiated an average of 8.5 days (range 3 to 15) after surgery and only very minor or no bleeding was observed. This trial indicates that the intrapulmonary infusion of rt-PA does not offer a significant benefit over the intravenous route and suggests that a prolonged infusion of rt-PA over 7 hr (100 mg) is superior to a single infusion of 50 mg over 2 hr.
