In this episode, I’ll discuss an article comparing half-dose to full-dose alteplase for pulmonary embolism.
The risk of hemorrhage is the major drawback to therapy with alteplase for any indication. When used for pulmonary embolism, a long-standing research question has been whether 50 mg of alteplase can treat PE just as well as 100 mg but with less bleeding.
A group of researchers recently published in Critical Care Medicine a multicenter retrospective observational study of 50 mg vs 100 mg alteplase for PE in order to expand the available data on this subject.
The authors compared 98 patients who were treated with 100 mg alteplase with 186 patients who were treated with 50 mg. Propensity score adjustments were made in an attempt to account for baseline differences between the two groups.
Both groups had significant improvements in clinically meaningful variables related to patients with pulmonary embolism such as shock index, blood pressure, heart rate, respiratory rate, and supplemental oxygen requirements.
Hemorrhagic complications were significantly less in the 50 mg group at just 13% compared to 24.5% in the 100 mg group. Looking only at major extracranial hemorrhage, this was also significantly less in the 50 mg group at just 1.1% compared to 6.1% in the 100 mg group.
The authors went further with their analysis and found that bleeding complications were associated with supratherapeutic levels of heparin anticoagulation in 37.5% of cases and invasive procedures in 31.3% of cases. However once propensity score weighting was applied, these differences lost statistical significance.
There were no significant differences between groups in terms of mortality, discharge destination, ICU or hospital length of stay, or readmission rate.
The authors concluded:
In a retrospective, PS-weighted observational study, when compared with the full-dose, reduced-dose alteplase results in similar outcomes but fewer hemorrhagic complications. Avoidance of excessive levels of anticoagulation or invasive procedures should be considered to further reduce complications.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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