Controlled thrombolysis of submassive PE

PulmCrit (EM Crit)

Controlled thrombolysis of submassive PE?

PulmCrit - January 18, 2016 - By Josh Farkas 

• "The ideal approach to dosing alteplase for thrombolysis of PE remains unclear.
• Patients’ response to alteplase varies depending on their balance of pro- vs. anti-fibrinolytic modulators.
• A slow peripheral alteplase infusion (e.g. 1 mg/hour infusion) could allow monitoring of the patient’s response to thrombolysis throughout the procedure, with discontinuation if there were excessive fibrinolysis or bleeding.
• Available data suggests that quarter-dose alteplase is effective. Based on data from >1,000 patients undergoing catheter-directed thrombolysis of PE or DVT, slow infusions of alteplase are safe.
• Controlled thrombolysis using a slow 25-mg alteplase infusion with protocoled monitoring might offer patients the benefit of lytic therapy with an extremely low risk of severe hemorrhage."