Journal
THROMBOSIS RESEARCH
Volume 133, Issue 3, Pages 357-363Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.thromres.2013.12.026
Keywords
Low dose; Pulmonary embolism; Thrombolytic therapy; rt-PA
Categories
Funding
- China Key Research Projects of the 12th National Five-Year Development Plan [2011BAI11B00]
- Natural Science Foundation of China [30810103904]
- Fund of Science and Technology of China [2006BAI01A06]
- Beijing Youth Star of Science and Technology Program [2007B037]
- National Natural Science Foundation of China [30810103904]
- capital health research and development of special [2011-1004-03]
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Background and Objective: According to US Food and Drugs Administration (FDA), 2 hour recombinant tissue plasminogen activator (rt-PA) 100 mg infusion is recommended for eligible patients with acute pulmonary embolism (PE). However, there exists evidence implying that a lower dosage of rt-PA can be equally effective but potentially safer compared with rt-PA 100 mg regimen. The aim of this systematic review and meta-analysis is to assess the efficacy and safety of low dose rt-PA in the treatment of acute PE. Material and Method: We searched Pubmed, EMBASE, the Cochrane library and CBM Literature Database for randomized controlled trials (RCT) focusing on low dose rt-PA for acute PE. Outcomes were described in terms of changes of image tests and echocardiography, major bleeding events, all-cause death, and recurrence of PE. Results: Five studies (440 patients) were included, three of which compared low dose rt-PA (0.6 mg/kg, maximum50 mg or 50 mg infusion 2 h) with standard dose (100 mg infusion 2 h). There were more major bleeding events in standard dose rt-PA group than in low dose group (OR 0.33, 95% CI 0.12-0.91; P = 0.94, I-2 = 0%), while there were no statistical differences in recurrent PE or all cause mortality between these two groups. Two studies compared low dose (0.6 mg/kg, maximum50 mg/2 min bolus or 10 mg bolus,= 40 mg/2 h) with heparin. There was no significant difference in major bleeding events (OR 0.73, 95% CI 0.14-3.98; P = 0.72), recurrent PE or all cause mortality. No dose-related heterogeneity was found for all the included studies. Conclusions: The results of this meta-analysis were hypothesis-generating. Based on the limited data, our systematic review suggested that low dose rt-PA had similar efficacy but was safer than standard dose of rt-PA. In addition, compared with heparin, low dose rt-PA didn't increase the risk of major bleeding for eligible PE patients. (C) 2013 Elsevier Ltd. All rights reserved.
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