PulmCrit (EMCrit)
PulmCrit - September 24, 2018 by Josh Farkas
..."Summary: The Bullet
- The optimal dose of tPA for PE remains unknown. No RCT has been able to demonstrate any difference in efficacy when comparing different doses. This is perhaps most notable within the recent OPTALYSE trial, which found equivalent results when using either ~24 mg, ~12 mg, or ~8 mg tPA.
- Most studies use fixed-dose tPA dosing. This fails to account for differences in patient weight or the patient’s balance between fibrinolysis versus fibrin generation. Failure to account for these variables could make fixed-dose tPA a shot in the dark: some patients will receive an excessive dose while other patients receive an inadequate dose.
- tPA should arguably be provided using weight-based dosing with titration to physiologic effect. It’s possible that dosing tPA in a precise fashion could allow for optimization of the risk/benefit ratio for each individual patient (rather than guessing a dose which will work OK across a diverse population of patients).
- The optimal dose of tPA for massive PE is unknown. 100 mg is the traditional dose, but 50 mg may be reasonable for patients at increased risk of bleeding who aren't acutely unstable."