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Poster Networking

Venous Thromboembolism

PB0380 - Thrombolytic treatment in reduced doses in patients with intermediate risk, safety and efficacy profile

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Nadejda Diaconu, Phd

    Asst. Profesor, dr. cardiolog,
    Institut of Cardiology,
    Chisinau, Chisinau, Moldova

    • Co-Author(s)

  • IC

    Irina Civirjic

    cardiologist
    State University of Medicine and Pharmacy Nicolae Testemitanu, doctoral school
    Chișinău, Chisinau, Moldova

  • GS

    Galina Sorici

    postdoc
    State University of Medicine and Pharmacy N. Testemitanu
    Chisinau, Chisinau, Moldova

Background: The role of thrombolysis in submassive pulmonary embolism (PE) is controversial due to the high risk of hemorrhage. Patients with intermediate-high risk pulmonary embolism (PE) who have acute right ventricular dysfunction and myocardial injury without overt hemodynamic compromise may be candidates for thrombolytic therapy (TT).

Aims: To compare the clinical outcomes of low-dose TT and unfractionated heparin (UFH) in intermediate-high risk PE patients.

Methods: In a prospective, non-randomized, open-label, single center trial, we compared 50 mg rt-PA plus unfractionated heparin (UFH) with UFH in intermediate-risk PE.The primary outcomes of the study were defined as a combination of death from any cause and hemodynamic decompensation, and severe or life-threatening bleeding. Secondary endpoints were recurrent PE, pulmonary hypertension, and moderate bleeding.

Results: The initial management strategy of intermediate-high risk PE was TT in 9(50%) patients and UFH in 9 (50.%) cases. Low-dose TT was successful in all patients. While the frequency of hypotension decreased significantly after TT (33,3 vs. 0%, P< 0.05). The proportion of hemodynamic decompensation was significantly lower in the TT group (33,3 vs. 11.%, p=0.06). The rate of secondary endpoints was higher in the UFH group (33,3 vs. 11,1%, P=0.06). Moreover, the prevalence of PHT was significantly higher in UFH group (0 vs. 22,2%, p=0.03). No significant differences were found between the two groups in terms of recurrent embolism (p=1.000 and p=0.778).Total death in the first 7 and 30 days was less in the half-dose rt-PA group than in the UFH group. There was no ICH in any of the patients. There were no significant differences between the groups in terms of major or minor bleeding.

Conclusion(s): Low dose TT regim of tissue plasminogen activator was found to be associated with a lower risk of hemodynamic decompensation and pulmonary hypertension in patients with acute intermediate-high-risk PE compared to UFH