Efficacy and Safety of Low-Dose Systemic Fibrinolytic Therapy for Acute Submassive Pulmonary Embolism

The review article discusses the options to extend anticoagulant therapy after completing the main anticoagulant therapy course in patients, who survived pulmonary embolism. It presents the results of randomized RE-MEDY and RE-SONATE studies of dabigatran, EINSTEIN-Extension study of rivaroxaban and AMPLIFY-Extension study of apixaban, which evaluated the feasibility, efficacy and safety of extended anticoagulant therapy with direct acting oral anticoagulants compared with placebo or warfarin. The article also provides the results of ASPIRE and WARFASA studies, which evaluated the possibility of using low-dose aspirin vs. Placebo for the extended treatment. The authors reviewed in details the results of einstein choice study, in which they compared the extended therapy with two doses of rivaroxaban (10 or 20 mg once a day) versus low (100 mg/day) doses of aspirin and against each other. The data obtained indicate that both doses of rivaroxaban significantly exceed aspirin in efficacy and reduce the risk of recurrent venous thrombosis by 74 and 66 %, respectively, without significantly increasing the risk of bleeding.

Download Full-text

Faculty Opinions recommendation of A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725755974.793557707 ◽

2019 ◽

Author(s):

Joanna Pepke-Zaba

Keyword(s):

Pulmonary Embolism ◽

Low Dose ◽

Multicenter Trial ◽

Submassive Pulmonary Embolism

Download Full-text

Worm-Like Thrombus in the Right Heart Treated with Low Dose Fibrinolytic Therapy in a Patient with Pulmonary Embolism

Kosuyolu Heart Journal ◽

10.5578/khj.5793 ◽

2015 ◽

Vol 18 (1) ◽

pp. 63-63

Author(s):

Yusuf Karavelioğlu

Keyword(s):

Pulmonary Embolism ◽

Low Dose ◽

Fibrinolytic Therapy ◽

Right Heart ◽

The Right

Download Full-text

Low-Dose Alteplase for the Treatment of Submassive Pulmonary Embolism: A Case Series

Journal of Pharmacy Practice ◽

10.1177/0897190019855164 ◽

2019 ◽

Vol 33 (5) ◽

pp. 708-711 ◽

Cited By ~ 1

Author(s):

Sara N. Layman ◽

Tommie J. Guidry ◽

Amanda R. Gillion

Keyword(s):

Pulmonary Embolism ◽

Right Ventricle ◽

Low Dose ◽

Case Series ◽

Bleeding Events ◽

Efficacious Treatment ◽

Increased Risk ◽

Submassive Pulmonary Embolism ◽

Successful Resolution ◽

Ventricle Size

Purpose: Pulmonary embolism (PE) can lead to significant morbidity and mortality. Thrombolytics are currently approved for the treatment of massive PE; however, the CHEST guidelines recommend against systemic thrombolytic use in acute PE patients without hypotension, unless these patients deteriorate on anticoagulation alone. Several studies have demonstrated the effectiveness of thrombolysis in submassive PE; however, the full thrombolytic dose resulted in significantly increased risk of non-intracranial bleeding and hemorrhagic stroke. The MOPETT trial demonstrated that low-dose tissue plasminogen activator (tPA) significantly reduced the risk of pulmonary hypertension and recurrent PE compared to anticoagulation alone in submassive PE patients without any bleeding events. Summary: This case series highlights 5 patient cases utilizing low-dose tPA for submassive PE. All patients had successful resolution of their symptoms and improvement in vitals and laboratory values. Furthermore, no patient had any bleeding during or after tPA administration. Three patients showed improved right ventricle function and reduced or normal right ventricle size on echocardiogram after tPA administration. Conclusion: The potential for low-dose tPA as a safe and efficacious treatment option for submassive PE is illustrated by this case series. However, larger, randomized controlled trials are needed to establish low-dose tPA as an accepted treatment modality.

Download Full-text