Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study
Abstract Background and aim The use of thrombolytics in intermediate-high risk pulmonary embolism (PE) remains controversial. This study evaluated the efficacy and safety of half-dose alteplase compared to anticoagulation with LMWH in this group. Material and methods Patients treated with thrombolyt...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-07-01
|
| Series: | The Egyptian Heart Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43044-025-00669-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849331729594056704 |
|---|---|
| author | Ömer Selim Selim Unat Pervin Korkmaz Akın Çinkooğlu Özge Can Elton Soydan Selen Bayraktaroğlu Gürsel Çok Recep Savaş Funda Karbek Akarca Sanem Nalbantgil Celal Çinar Mehmet Uyar Kubilay Demirağ Tahir Yağdi Çağatay Engin Münevver Erdinç Feza Bacakoğlu |
| author_facet | Ömer Selim Selim Unat Pervin Korkmaz Akın Çinkooğlu Özge Can Elton Soydan Selen Bayraktaroğlu Gürsel Çok Recep Savaş Funda Karbek Akarca Sanem Nalbantgil Celal Çinar Mehmet Uyar Kubilay Demirağ Tahir Yağdi Çağatay Engin Münevver Erdinç Feza Bacakoğlu |
| author_sort | Ömer Selim Selim Unat |
| collection | DOAJ |
| description | Abstract Background and aim The use of thrombolytics in intermediate-high risk pulmonary embolism (PE) remains controversial. This study evaluated the efficacy and safety of half-dose alteplase compared to anticoagulation with LMWH in this group. Material and methods Patients treated with thrombolytics (50 mg alteplase) after the establishment of EGEPET (2.10.2018) formed the prospective group, while the retrospective group included patients treated with LMWH (enoxaparin) before EGEPET. Primary outcomes were one-month and one-year mortality. Secondary outcomes were vital sign changes after thrombolysis, hemorrhagic events, recurrence of embolism, chronic pulmonary thromboembolism (CPTE), and chronic thromboembolic pulmonary hypertension (CTEPH). Results Thrombolytic group (n = 59) and anticoagulation group (n = 38) were similar in age, comorbidities, and vital signs, except for higher pulse rates in the thrombolytic group. In the thrombolytic group, PaO₂/FiO₂ ratio significantly improved [330 (270–380) to 417 (351–447), p < 0.001], and pulse rate decreased [116 (105–127) to 91 (80–104), p < 0.001]. In the anticoagulation group, oxygenation showed no significant change, but pulse rate improved. No major bleeding occurred in either group. One-month mortality was 6.7% in the thrombolytic group and 15.8% in the anticoagulation group (p = 0.18). One-year mortality was 13.7% and 26.3%, respectively (p = 0.17). Advanced age (> 67) (OR: 8.82, %95 CI 1.54 – 50.53 p = 0.014) and elevated second-day pulse > 94/min (OR 7.61, 95% CI 1.33–43.49, p = 0.022) were independent predictors of one-month mortality in the multivariate analysis. Conclusion Thrombolytic therapy significantly improved oxygenation and clinical findings without major complications. Although mortality rates were lower in the thrombolytic group, the difference was not statistically significant. These results should be interpreted with caution, and larger prospective studies are needed to confirm the clinical efficacy and safety of thrombolytic therapy in this patient population. |
| format | Article |
| id | doaj-art-4591f9a2371548da846a8d5edf57fd87 |
| institution | Kabale University |
| issn | 2090-911X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Heart Journal |
| spelling | doaj-art-4591f9a2371548da846a8d5edf57fd872025-08-20T03:46:25ZengSpringerOpenThe Egyptian Heart Journal2090-911X2025-07-0177111010.1186/s43044-025-00669-5Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational studyÖmer Selim Selim Unat0Pervin Korkmaz1Akın Çinkooğlu2Özge Can3Elton Soydan4Selen Bayraktaroğlu5Gürsel Çok6Recep Savaş7Funda Karbek Akarca8Sanem Nalbantgil9Celal Çinar10Mehmet Uyar11Kubilay Demirağ12Tahir Yağdi13Çağatay Engin14Münevver Erdinç15Feza Bacakoğlu16Dr. Suat Seren Göğüs Hastalıkları HastanesiEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityEge UniversityAbstract Background and aim The use of thrombolytics in intermediate-high risk pulmonary embolism (PE) remains controversial. This study evaluated the efficacy and safety of half-dose alteplase compared to anticoagulation with LMWH in this group. Material and methods Patients treated with thrombolytics (50 mg alteplase) after the establishment of EGEPET (2.10.2018) formed the prospective group, while the retrospective group included patients treated with LMWH (enoxaparin) before EGEPET. Primary outcomes were one-month and one-year mortality. Secondary outcomes were vital sign changes after thrombolysis, hemorrhagic events, recurrence of embolism, chronic pulmonary thromboembolism (CPTE), and chronic thromboembolic pulmonary hypertension (CTEPH). Results Thrombolytic group (n = 59) and anticoagulation group (n = 38) were similar in age, comorbidities, and vital signs, except for higher pulse rates in the thrombolytic group. In the thrombolytic group, PaO₂/FiO₂ ratio significantly improved [330 (270–380) to 417 (351–447), p < 0.001], and pulse rate decreased [116 (105–127) to 91 (80–104), p < 0.001]. In the anticoagulation group, oxygenation showed no significant change, but pulse rate improved. No major bleeding occurred in either group. One-month mortality was 6.7% in the thrombolytic group and 15.8% in the anticoagulation group (p = 0.18). One-year mortality was 13.7% and 26.3%, respectively (p = 0.17). Advanced age (> 67) (OR: 8.82, %95 CI 1.54 – 50.53 p = 0.014) and elevated second-day pulse > 94/min (OR 7.61, 95% CI 1.33–43.49, p = 0.022) were independent predictors of one-month mortality in the multivariate analysis. Conclusion Thrombolytic therapy significantly improved oxygenation and clinical findings without major complications. Although mortality rates were lower in the thrombolytic group, the difference was not statistically significant. These results should be interpreted with caution, and larger prospective studies are needed to confirm the clinical efficacy and safety of thrombolytic therapy in this patient population.https://doi.org/10.1186/s43044-025-00669-5Pulmonary embolismIntermediate-high riskThrombolysisHalf-dose alteplaseLow molecular Weight heparinReal-life study |
| spellingShingle | Ömer Selim Selim Unat Pervin Korkmaz Akın Çinkooğlu Özge Can Elton Soydan Selen Bayraktaroğlu Gürsel Çok Recep Savaş Funda Karbek Akarca Sanem Nalbantgil Celal Çinar Mehmet Uyar Kubilay Demirağ Tahir Yağdi Çağatay Engin Münevver Erdinç Feza Bacakoğlu Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study The Egyptian Heart Journal Pulmonary embolism Intermediate-high risk Thrombolysis Half-dose alteplase Low molecular Weight heparin Real-life study |
| title | Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study |
| title_full | Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study |
| title_fullStr | Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study |
| title_full_unstemmed | Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study |
| title_short | Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study |
| title_sort | comparison of half dose alteplase and lmwh in intermediate high risk pulmonary embolism a single center observational study |
| topic | Pulmonary embolism Intermediate-high risk Thrombolysis Half-dose alteplase Low molecular Weight heparin Real-life study |
| url | https://doi.org/10.1186/s43044-025-00669-5 |
| work_keys_str_mv | AT omerselimselimunat comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT pervinkorkmaz comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT akıncinkooglu comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT ozgecan comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT eltonsoydan comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT selenbayraktaroglu comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT gurselcok comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT recepsavas comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT fundakarbekakarca comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT sanemnalbantgil comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT celalcinar comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT mehmetuyar comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT kubilaydemirag comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT tahiryagdi comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT cagatayengin comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT munevvererdinc comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy AT fezabacakoglu comparisonofhalfdosealteplaseandlmwhinintermediatehighriskpulmonaryembolismasinglecenterobservationalstudy |