Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism.
Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism.
复制标题
半剂量与全剂量高倍酶治疗肺栓塞。
DOI：
10.1097/ccm.0000000000003288
复制
发表时间：
2018-10
影响因子：
8.8
通讯作者：
Vandivier RW
中科院分区：
文献类型：
--
作者：
Kiser TH;Burnham EL;Clark B;Ho PM;Allen RR;Moss M;Vandivier RW
Recent evidence suggests that half-dose thrombolysis for pulmonary embolism (PE) may provide similar efficacy with reduced bleeding risk compared to full-dose therapy, but comparative studies are lacking. We aimed to evaluate the effectiveness and safety of half-dose versus full-dose alteplase for treatment of PE. A retrospective cohort study comparing outcomes in patients receiving half-dose (50 mg) versus full-dose (100 mg) alteplase for PE. We used propensity score matching and sensitivity analyses to address confounding and hospital-level clustering. Data from 420 hospitals obtained from the Premier Healthcare Database between January 2010 and December 2014. Adult critically ill patients with acute PE treated with intravenous alteplase therapy. None This study included 3,768 patients: 699 (18.6%) in the half-dose and 3,069 (81.4%) in the full-dose group. At baseline, patients receiving half-dose alteplase required vasopressor therapy (23.3% vs. 39.4%, p<0.01) and invasive ventilation (14.3% vs. 28.5%, p<0.01) less often, compared to full-dose. After propensity matching (n=548 per group), half-dose alteplase was associated with increased treatment escalation (53.8% vs. 41.4%, p<0.01), driven mostly by secondary thrombolysis (25.9% vs. 7.3%, p<0.01) and catheter thrombus fragmentation (14.2% vs. 3.8%, p<0.01). Hospital mortality was similar (13% vs. 15%, p=0.3). There was no difference in cerebral hemorrhage (0.5% vs. 0.4%, p=0.67), gastrointestinal bleeding (1.6% vs. 1.6%, p=0.99), acute blood loss anemia (6.9% vs. 4.6%, p=0.11), use of blood products (p>0.05 for all), or documented fibrinolytic adverse events (2.6% vs. 2.8%, p=0.82). Compared to full-dose alteplase, half-dose was associated with similar mortality and rates of major bleeding. Treatment escalation occurred more often in half-dose treated patients. These results question whether half-dose alteplase provides similar efficacy with improved safety, and highlights the need for further study before use of half-dose alteplase therapy can be routinely recommended in patients with PE.
