Hemodynamic effects of double bolus reteplase versus alteplase infusion in massive pulmonary embolism☆,☆☆,★
Section snippets
Methods
The study protocol was approved by Göttingen University’s Ethical Review Committee and was conducted in 9 centers throughout Germany.
Patient characteristics
Thirty-six patients were enrolled between May 1994 and October 1996. Twenty-three patients were treated with reteplase and 13 patients received alteplase. The patients of the 2 groups were well matched for baseline characteristics. As displayed in Table I there were no significant differences between the 2 groups with respect to age, height, sex, onset of symptoms, stage of pulmonary embolism, clinical symptoms, or baseline hemodynamic characteristics.
Discussion
The primary objective of the study was to compare the effects of double bolus reteplase with the standard regimen of alteplase in patients with acute pulmonary embolism. The study was specifically designed to evaluate early hemodynamic changes during the first few hours after administration of the thrombolytic. High total pulmonary resistance, high pulmonary artery pressure, and low cardiac index are immediately life-threatening in the most severely affected patients. The mean pulmonary artery
Acknowledgements
We thank Egon Pfarr, MSc, and Adalbert Smolartz, MD, for their extremely valuable contributions.
References (22)
- et al.
Natural history of pulmonary embolism
Prog Cardiovasc Dis
(1975) - et al.
Mortality from pulmonary embolism in the United States 1962 - 1984
Chest
(1990) - et al.
Acute pulmonary embolism treated with tissue plasminogen activator
Lancet
(1986) - et al.
Randomized controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism
Lancet
(1988) - et al.
Paims 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator. Italian multicenter study 2
J Am Coll Cardiol
(1992) - et al.
Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: a European multicenter double-blind trial
J Am Coll Cardiol
(1992) - et al.
Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: a randomized controlled multicenter trial
J Am Coll Cardiol
(1992) - et al.
Evaluation of thrombolytic and systemic effects of the novel recombinant plasminogen activator BM 06.022 compared with alteplase, anistreplase, streptokinase and urokinase in a canine model of coronary artery thrombosis
J Am Coll Cardiol
(1992) - et al.
Hemodynamic effects of bolus vs 2-h infusion of alteplase in acute massive pulmonary embolism. A randomized controlled multicenter trial
Chest
(1994) - et al.
Effectiveness and safety of bolus administration of alteplase in massive pulmonary embolism
Am J Cardiol
(1992)
Cited by (124)
What are the indications and options for vascular reperfusion in the acute phase of pulmonary embolism?
2021, Revue des Maladies RespiratoiresPrevention of early complications and late consequences after acute pulmonary embolism: Focus on reperfusion techniques
2018, Thrombosis ResearchCitation Excerpt :These agents can be delivered via a peripheral venous catheter as a loading dose followed by continuous infusion, or as accelerated regimens with infusion times ranging from 15 min (alteplase) to 2 h (alteplase, streptokinase, urokinase) [2]. Other thrombolytic drugs such as tenecteplase [11], reteplase [12] and desmoteplase [13], which have been evaluated in therapeutic trials in patients with acute PE, did not receive formal approval for this indication. The efficacy and safety of systemic thrombolysis for acute PE has been highlighted in a meta-analysis of 15 randomized controlled trials, which included a total of 2057 subjects with PE [14].
Thrombolysis with reteplase in acute pulmonary embolism
2019, Indian Heart JournalCitation Excerpt :Before our study, one small randomized trial and few case studies have evaluated the efficacy of reteplase for PE. In a randomized trial of 36 patients (23, reteplase and 13, alteplase), Tebbe et al17 demonstrated that reteplase led to greater and more rapid improvement in total pulmonary resistance, mean pulmonary artery pressure, and the cardiac index compared with alteplase. However, there was no difference at 24 h between the two groups.
Fibrinolytic Agents in Thromboembolic Diseases: Historical Perspectives and Approved Indications
2024, Seminars in Thrombosis and Hemostasis
- ☆
Supported by research grants from Boehringer Mannheim Therapeutics, Mannheim, Germany.
- ☆☆
Reprint requests: Ulrich Tebbe, MD, Medizinische Klinik Lippe-Detmold, Röntgenstraße 18, 32756 Detmold, Germany.
- ★
0002-8703/99/$8.00 + 0 4/1/94905