Clinical Efficiency And Safety Of Reteplase In The Treatment Of Acute Pulmonary Embolism

Background: In recent years, pulmonary embolism has become acommon diseases of the cardiovascular system in our country. TheAPTE(acute pulmonary thromboembolism), with its features of highincidence, morbidity and mortality rates (untreated APTE mortality rate ashigh as30%), has become one of key research medical problems of ourcountry in present. The main purpose of the treatment of acute pulmonaryembolism is to make the flow of pulmonary embolism reperfusion. At presentthe thrombolytic therapy is mainly used to achieve this purpose in clinical.thrombolytic therapy can make the blocking pulmonary artery thrombusdissolving in whole or in part, terminate the pulmonary artery embolism,reduce pulmonary artery pressure, decrease the afterload of right ventricular,reverse the function failure of right heart, so as to achieve the purpose ofreducing the clinical symptoms of patients and decrease the mortality. It isreported, thrombolytic therapy can also partly dissolve deep vein thrombosis,which reduce pulmonary emboli sources, reduce the recurrence of pulmonaryartery embolism and occurrence of chronic pulmonary arterial hypertension.Because of the severity of the patient’s condition is directly related to thechoice of treatment strategy and prognosis, especially in deciding whether tothrombolytic therapy, it is particularly important for patients with APTE tomake risk stratification. It is mainly depends on the clinical manifestation ofpatients, especially the judgment of cardiac function and pulmonary function,and some indexes evaluation and so on to complete risk stratification ofpatients with APTE. Currently thrombolytic drugs in clinical areurokinase(UK), streptokinase (SK) and recombinant tissue plasminogenactivator (rt-PA). Because both UK and SK do not have plasminogenspecificity, prone to bleeding complications, does not apply to emergencythrombolytic therapy; while rt-PA, which has selectivity to fibrin, lowerbleeding and other adverse reactions, is often used in emergency thrombolytictherapy. Compared with the second generation, the third generation ofreteplase thrombolytic drugs such as Reteplasc(r-PA), in addition to the better fiber thrombolytic drug protein specificity, thrombolytic potency, lowerbleeding caused by the characteristics of the adverse reaction, also hascharacteristics as a long half-life, can be intravenous injection, easy to use andso on. Currently, in our country there is still a few clinical research data aboutr-PA thrombolytic therapx thrombolytic of thrombolytic regimens, clinicalefficacy, prognostic impact and safety in patients with APTE.Objectives: This study is intended to investigate the thrombolyticregimens. Efficacy and safety of r-PA thrombolysis therapy in patients withAPTE. With the comparison of the thrombolysis effect by rt-PA,Thesefindings may provide the basis for treating patients with APTE.Methods:1. From January2012to December2013, a total number of42patientswith APTE who were diagnosed in the Second Hospital of Hebei MedicalUniversity were enrolled. All patients were diagnosed with acute pulmonarythromboembolism, and accept the related examination. All patients wererandomly divided into two groups (22in the treatment group and20in thecontrol group). All patients are in line with the standard of thrombolysis foracute pulmonary thromboembolism.2. Both groups of patients before thrombolysis for ordinary heparintreatment, according to the80IU/kg intravenous injection. The treatmentgroup was treated with intravenous injection of r-PA(18mg intravenousinjection slowly, for more than2min, after30min intervals for another18mg).The control group once againwere treated with intravenous injection of rt-PAwithout load (50mg Continuous intravenous drip of2h). After thethrombolysis treatment using Dalteparin Sodium, subcutaneous injection5000IU, BID,3to5days. At the same time use warfarin anticoagulationtherapy,3mg/d, according to INR (ratio of International standardization,International normalized thewire)(control between2-3) adjusting dosage.Usually treatment for6months, according to the individual situation can beappropriately extended course of treatmen. Blood gas analysis and bloodcoagulation were reviewed after4hours, cardiac uhrasonography werereviewed after48-72hours, DSCT-PA were reviewed after3days treatment. 3. The efficacy was evaluated based on6grades: cured, markedlyimproved, improved, not changed, deteriorated and died. To calculate theeffective rate use the sum of the cured, markedly improved and improved, tocalculate the incidence of serious incident ues the sum of the deteriorated anddied.4. Observing the thrombolytic therapy for the incidence of bleedingcomplications, the severe bleeding include the intracranial hemorrhage andblooding amount is greater than1000ml. Subcutaneous bleeding, puncturebleeding, gingival bleeding were mild bleeding; The moderate bleeding is thebieeding,which is between mild bleeding and severe bleeding.5. To understand and evaluate the short-term prognosis (bleeding,recurrence and death dates) of patients with APTE. through follow-up3months.6. The data was analyzed according to the statistical software ofSPSS19.0. it was statistically significant difference of P<0.05. it uas extremelysignificant difference of P<0.01.Results:1. The basic clinical characteristics，the clinical course and the cause oftwo group patients were no statistically significant difference (P>0.05).2. Compared with the control group, the clinical symptoms (difficultyinbreathing, chest pain, et al)changed significantly as more as the treatmentgroup. There was no statistically significant difference between the twogroups(P＞0.05).3. The clinical indicators such as pulmonary embolism areas, respiratoryfrequency, heart rate, PASP, PaO2, PaCO2and SaO2changed significantly aftertreatment in the two groups (P<0.05or P<0.01). There was no statisticallysignificant difference in therapeutic effect between the two roups(P＞0.05).4. The effective rates of two groups were respectively81.81%and75.00%.There was no statistically significant difference between the two groups(Χ2＝0.026，P＝0.872＞0.05)5. After thrombolytic therapy，there was a total of8cases with bleeding events in the treatment group; On the other side, there was a total of5caseswith bleeding events in the control group, there was no serious bleeding in thetwo groups of patients. There was no statistically significant difference inbleeding rates between the two groups (treatment group36.36%vs.controlgroup30.00%. Χ2＝0.191P=0.662＞0.05). All bleeding patients wererecovered after treatment.6. From the hospital to the end of the follow-up, two groups had noserious events (progression, recurrence and death).Conclusions:1. After thrombolytic therapy, no matter use t-PA or rt-PA., the patient’sclinical symptoms were improved quickly.2. Compare with rt-PA, r-PA has the same efficient but did not increasethe risk of bleeding.3. Thrombolytic therapy with r-PA to patients is safe, effective and hasbetter cost-effective.