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.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply