Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism*

Objectives: Recent evidence suggests that half-dose thrombolysis for pulmonary embolism may provide similar efficacy with reduced bleeding risk compared with full-dose therapy, but comparative studies are lacking. We aimed to evaluate the effectiveness and safety of half-dose versus full-dose alteplase for treatment of pulmonary embolism. Design: A retrospective cohort study comparing outcomes in patients receiving half-dose (50 mg) versus full-dose (100 mg) alteplase for pulmonary embolism. We used propensity score matching and sensitivity analyses to address confounding and hospital-level clustering. Setting: Data from 420 hospitals obtained from the Premier Healthcare Database between January 2010 and December 2014. Subjects: Adult critically ill patients with acute pulmonary embolism treated with IV alteplase therapy. Interventions: None. Measurements and Main Results: This study included 3,768 patients: 699 (18.6%) in the half-dose and 3,069 (81.4%) in the full-dose group. At baseline, patients receiving half-dose alteplase required vasopressor therapy (23.3% vs 39.4%; p 0.05 for all), or documented fibrinolytic adverse events (2.6% vs 2.8%; p = 0.82). Conclusions: Compared with full-dose alteplase, half-dose was associated with similar mortality and rates of major bleeding. Treatment escalation occurred more often in half-dose–treated patients. These results question whether half-dose alteplase provides similar efficacy with improved safety, and highlights the need for further study before use of half-dose alteplase therapy can be routinely recommended in patients with pulmonary embolism.

from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2D0lpWC