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Low dose prolonged infusion of tissue type plasminogen activator therapy in massive pulmonary embolism

Session Poster session 4

Speaker Associate Professor Ahmet Cagri Aykan

Event : ESC Congress 2016

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Embolism
  • Session type : Poster Session

Authors : AC Aykan (Trabzon,TR), T Gokdeniz (Trabzon,TR), D Altintas Aykan (Trabzon,TR), E Kalaycioglu (Trabzon,TR), I Gul (Trabzon,TR), CY Karabay (Istanbul,TR), M Yildiz (Istanbul,TR), E Hatem (Trabzon,TR), F Boyaci (Samsun,TR), S Celik (Trabzon,TR)

Authors:
A.C. Aykan1 , T. Gokdeniz1 , D. Altintas Aykan2 , E. Kalaycioglu1 , I. Gul1 , C.Y. Karabay3 , M. Yildiz4 , E. Hatem1 , F. Boyaci5 , S. Celik1 , 1Ahi Evren Education and Research Hospital - Trabzon - Turkey , 2KTU, Farabi Hospital - Trabzon - Turkey , 3Kartal Kosuyolu Heart Education and Research Hospital - Istanbul - Turkey , 4Istanbul University Cardiology Institute, Cardiology - Istanbul - Turkey , 5Samsun Education and Research Hospital, Cardiology - Samsun - Turkey ,

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 755

Objective: Pulmonary embolism (PE) has a high mortality but the in-hospital all-cause case mortality rates were lower in unstable patients who received thrombolytic therapy (TT) than those who did not. However TT is associated with major complications. The aim of the present study was to assess the efficacy and safety of low-dose (25mg) prolonged administration (in 6 hours) of tissue-type-plasminogen-activator (tPA) on in-hospital mortality and outcomes in patients with massive PE.

Methods: A total of 52 consecutive patients with massive PE were included in this study. The primary end-points consisted of in hospital all cause mortality, major complications, pulmonary hypertension and right ventricular dysfunction. Secondary end-points are all cause mortality, pulmonary hypertension and right ventricular dysfunction at 6 month. This study is registered NCT02029456.

Results: The mean age of the patients was 72.80±15.25. The mean pulmonary artery systolic pressure (PASP) (55.40±8.30 mmHg vs. 33.20±3.27 mmHg, p<0.001), right/left ventricle (RV/LV) diameter (1.35±0.11 vs 0.98±0.13, p<0.001) were significantly decreased after the TT. Tricuspid annular plane systolic excursion (1.44±0.42 cm vs. 2.02±0.29 cm, p<0.001), TEI index (0.61±0.04 vs 0.58±0.05, p<0.001), s' (9.7±2.9 vs 15.1±2.7) were significantly increased after TT. No major bleeding was observed. None of the patients had stroke or transient ischemic attack. In hospital mortality was one and total mortality was four. Pulmonary hypertension was not developed during follow up. Of the 52 patients 30 patients underwent control tomography angiography 24 hours after the completion of TT. Complete lysis of thrombus was observed in 28 of the 30 patients. The echocardiographic outcomes of the patients were presented in Table 1.

Conclusion: Low dose prolonged infusion of tPA is an effective and safe therapy in patients with massive PE. This protocol is also effective in decreasing PASP and restoration of RV functions.

Table 1
VariableOn admissionPost-TTPre-discharge6 month
PABS, mmHg55.40±8.3033.20±3.2729.42±3.3527.80±5.01
TAPSE, cm1.44±0.422.02±0.292.16±0.242.21±0.30
MPI0.61±0.040.58±0.050.53±0.080.45±0.09
S' cm/sec9.6±2.8215.1±2.7316.4±2.5817.2±3.65
RV/LV1.35±0.110.98±0.130.85±0.110.65±0.14

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