Circulation, Vol 77, 353-360, Copyright © 1988 by American Heart Association
M Verstraete, GA Miller, H Bounameaux, B Charbonnier, JP Colle, G Lecorf, GA Marbet, P Mombaerts and CG Olsson
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 5,000 IU followed
by 1,000 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 less than .005) and 15% in the intravenous drug group (p less
than .005); mean pulmonary arterial pressure fell from 31 +/- 7 to 22 +/- 6
mm Hg (p less than .005) and from 31 +/- 12 to 21 +/- 9 mm Hg (p less than
.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 sites 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.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism
Center for Thrombosis and Vascular Research, Campus Gasthuisberg, Leuven, Belgium.
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