Comparison of long‐term outcomes of 50 and 100 mg rt‐PA in the management of acute pulmonary thromboembolism

Elif Yilmazel Ucar, Omer Araz, Bugra Kerget, Nafiye Yilmaz, Metin Akgun, Leyla Saglam

Pulmonary thromboembolism (PTE) is a life-threatening disease. In this study, we aimed to evaluate long-term outcomes of the use of 50 mg recombinant tissue-type plasminogen activator (rt-PA) in the management of PTE in terms of relapse, pulmonary hypertension (PH), mortality and hemorrhage, and to compare with the use of 100 mg rt-PA. The study was designed as a retrospective cohort. Patients who were diagnosed as acute PTE and received either 50 mg or 100 mg rt-PA in a tertiary care hospital between 2010 and 2015 were included in the study. Rates of relapse, PH, mortality (in-hospital and long-term) and hemorrhage (major and minor) were calculated for each treatment group. A total 117 patients, 73 female and 44 male, were evaluated. Eighty-three patients were administered 100 mg rt-PA and 34 were administered 50 mg rt-PA. Mean age was lower in the 100 mg group compared to the 50 mg group (61±15 versus 69±14 years). There was a significant decrease in PH in each group at 3 months follow-up (p<0.001). Although statistically nonsignificant, the relapse rate was lower in the 50 mg rt-PA group, but the 5-year mortality rate was higher in 50 mg rt-PA group (35.2% versus 27.7%, p=0.50). Mortality was associated with older age and presence of malignancy. Our results suggest that both doses of rt-PA have similar efficacy. The high mortality rate in the 50 mg group may have resulted from patient selection. This article is protected by copyright. All rights reserved.