ALTEPLASE VERSUS HEPARIN IN ACUTE PULMONARY-EMBOLISM - RANDOMIZED TRIAL ASSESSING RIGHT-VENTRICULAR FUNCTION AND PULMONARY PERFUSION
ALTEPLASE VERSUS HEPARIN IN ACUTE PULMONARY-EMBOLISM - RANDOMIZED TRIAL ASSESSING RIGHT-VENTRICULAR FUNCTION AND PULMONARY PERFUSION
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DOI：
10.1016/0140-6736(93)90274-k
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发表时间：
1993-02-27
期刊：
影响因子：
168.9
通讯作者：
BRAUNWALD, E
中科院分区：
文献类型：
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作者：
GOLDHABER, SZ;HAIRE, WD;BRAUNWALD, E
一项非随机研究的数据表明，在急性肺栓塞（PE）患者中，溶栓后肝素比单独肝素更快地逆转右心室功能障碍并恢复肺组织灌注。我们在一项随机方案中追求这一想法。46例血流动力学稳定的患者随机接受重组组织型纤溶酶原激活剂（阿替普酶，rt-PA）100 mg，2 h后静脉注射肝素，55例仅接受肝素。定性评估右心室壁运动，并通过平面测量法从基线和3小时和24小时的超声心动图估计右心室舒张末期面积。在基线和24小时获得肺灌注扫描。在39%的rt-PA患者中，24小时右心室壁运动较基线改善，而仅在17%的肝素单药治疗患者中，分别有2%和17%的患者右心室壁运动恶化（p=0.005）。rt-PA患者在随机化后24小时内右心室舒张末期面积也显著减少，绝对值显著增加。肺灌注改善（14.6% vs 1.5%）。在rt-PA患者中未观察到复发性PE的临床发作，但在随机分配至肝素单药组的患者中，14天内发生了2例致死性和3例非致死性临床疑似复发性PE。rt-PA可迅速改善PE患者的右心室功能和肺灌注，并可能降低不良临床结局的发生率。
Data from a non-randomised study have hinted that in patients with acute pulmonary embolism (PE), thrombolysis followed by heparin more rapidly reverses right-ventricular dysfunction and restores pulmonary tissue perfusion than does heparin alone. We have pursued this idea in a randomised protocol.46 haemodynamically stable patients were randomised to recombinant tissue plasminogen activator (alteplase, rt-PA) 100 mg over 2 h followed by intravenous heparin and 55 to heparin alone. Right-ventricular wall motion was assessed qualitatively, and right-ventricular end diastolic area was estimated by planimetry from echocardiograms at baseline and at 3 and 24 hours. Pulmonary perfusion scans were obtained at baseline and 24 hours. In 39% of rt-PA patients but in only 17% of heparin alone patients right-ventricular wall motion at 24 hours had improved from baseline and in 2% and 17%, respectively, it worsened (p=0.005). rt-PA patients also had a significant decrease in right-ventricular end-diastolic area during the 24 hours after randomisation and a significant absolute. improvement in pulmonary perfusion (14.6% vs 1.5%). No clinical episodes of recurrent PE were noted among rt-PA patients, but there were 2 fatal and 3 non-fatal clinically suspected recurrent PEs within 14 days in patients randomised to heparin alone. rt-PA rapidly improves right-ventricular function and pulmonary perfusion among patients with PE and may lead to a lower rate of adverse clinical outcomes.