| Background With the awareness of diagnosis of clinical physicians and the development of diagnostic techniques, acute pulmonary thromboembolism (APTE) has become a common cardiovascular disease in China. The mortality rate of APTE is very high, which can be up to30%if untreated, which has been attached great importance by physicians of clinical subjects. At present, the main method of treatment for patients with APTE are thrombolysis and anticoagulation therapy, thrombolytic therapy is controversial in patients with intermediate-risk APTE (hemodynamic stability with evidence of right ventricle dysfunction and/or myocardial injury) according to the new risk stratification. The focus of controversy is the risk of blooding by the thrombolytic therapy. Now. a new generation of thrombolytic agents of reteplase (r-PA) has strong fibrin specificity, has no effect on platelets, lower bleeding adverse reactions, is stronger role in thrombolysis. is longer half-life, can be the direct administration of the intravenous injection, and is convenient for application. So r-PA is gaining the attention of clinicians. At present, in our country it is still a few of clinical research data about r-PA thrombolytic therapy thrombolytic of thrombolytic regimens, clinical efficacy, prognostic impact and safety in patients with intermediate-risk APTE.Objectives This study is intended to investigate the thrombolytic regimens, efficacy and safety of r-PA thrombolysis therapy in patients with intermediate-risk APTE. also to understand and evaluate the short-term prognosis of patients with intermediate-risk APTE through follow-up. These findings may provide the basis for treating patients with intermediate-risk APTE. Methods1. From January2010to November2011, A total number of45patients with intermediate-risk APTE who were diagnosed by dual-source computer tomography pulmonary angiography (DSCT-PA) in Anyang City People’s Hospital were enrolled. All patients were randomly divided into two groups (23in the thrombolytic and22in the anticoagulant group). All patients are in line with the ESC guidelines on diagnostic and treatment of APTE. which was developed in2008.2. The thrombolytic group were treated with intravenous injection of low dose r-PA r-PA (18mg), followed by using low molecular weight heparin (LMWH) and warfarin anticoagulation therapy. Warfarin (taking at least3months) and heparin overlap the use of3-5d. The anticoagulant group was using LMWH and warfarin alone, usage as thrombolytic group. While observing the patient’s vital signs, monitoring of clinical indicators. Echocardiography and DSCT-PA were reviewed after3days treatment. The clinical data of45patients with intermediate-risk APTE were analyzed retrospectively after3days treatment.3. The efficacy was evaluated based on6grades:cured, markedly improved, improved, not changed, deteriorated and died. The safety was evaluated based on risk of bleeding.4. To understand and evaluate the short-term prognosis (bleeding, recurrence and death dates) of patients with intermediate-risk APTE. through follow-up3months.5. The data was analyzed according to the statistical software of SPSS17.0, it was statistically significant difference of P<0.05. it was extremely significant difference of P<0.01.Results1. The basic clinical characteristics and the cause of two group patients were no statistically significant difference (P>0.05).2. Compared with the anticoagulant group. the clinical symptoms (difficulty in breathing, chest pain, et al)changed more significantly in the thrombolytic group.The clinical indicators such as pulmonary embolism areas, respiratory frequency, heart rate. PASP. PaO2, PaCO2, and SaO2changed significantly after3days treatment in the two groups (P<0.05or P<0.01). Compared with the anticoagulant group, all above indicators changed more significantly in the thrombolytic group (P<0.05).3. After3days treatment, compared with the anticoagulant group, the thrombolytic group had higher cure rate(26.09%vs.4.55%. P=0.0460.05). higher effective rate (defined as patients who were cured, markedly improved or improved.86.96%vs.50.00%. P=0.007<0.01). lower critical event occurrence (defined as clinical condition deteriorated or died.18.18%vs.0, P=0.032<0.05).4. After3days" treatment, each group had two cases of mild bleeding. but no major bleeding or intracranial hemorrhage occurred. There was no statistically significant difference in bleeding rates between the two groups (thrombolysis group8.70%vs. anticoagulation group9.09%. P=0.963>0.05).5. From hospital treatment to the end of the3month follow-up, compared with the anticoagulant group, the thrombolytic group had lower critical event occurrence (defined as clinical condition deteriorated, relapsed or died.(22.72%vs.0. P=0.015<0.05): higher no event rate(86.96%vs.68.18%).but no statistical!) significant difference (P=0.130>0.05). each group was no major bleeding or intracranial hemorrhage occurred: thrombolysis group mild bleeding rates was13.04%. but no deterioration, recurrence and death: anticoagulation group mild bleeding rates was9.09%. deterioration rates13.64%. recurrence rates4.55%and death rates4.55%. There was no statistically significant difference in bleeding rates between the two groups (13.04%vs.9.09%.P=0.673>0.05).Conclusions1. Reteplase thrombolytic therapy compared with anticoagulant therapy alone in patients with intermediate-risk APTE can more rapidly improve the clinical symptoms, dissolve blood clots, improve pulmonary hemodynamics and correct right ventricular function.2. Reteplase thrombolytic therapy compared with anticoagulant therapy alone in patients with intermediate-risk APTE have a higher cure rate and effective rate, can reduce the incidence of recent serious incidents (deterioration+recurrence+death), but do not increase the risk of bleeding.3. Reteplase thrombolytic regimen has better efficacy and safety in treating intermediate-risk APTE. We suggest that reteplase regimen could be used for intermediate-risk APTE treatment. |
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