EXTENDED INFUSION OF RTPA LYSIS OF PULMONARY EMBOLI - INFLUENCE OF TIME AFTER ONSET OF SYMPTOMS ON OUTCOME

Purpose: Evaluate efficacy and safety of short-term thrombolysis with recombinant human-tissue plasminogen activator (rtPA). Methods: Thromb olysis with rtPA was performed in 29 patients with angiographically do cumented severe acute pulmonary embolism (Miller score of 20/34 or mor e), All patients received 100 mg rtPA through peripheral veins within the first 2 hr, followed by a continuous infusion of rtPA (0.05 mg/kg/ hr) over a 4-hr period. Concomitant intravenous heparin 1000 U/hr infu sion was applicated for the first 6 hr. Results: Using this treatment, 83% of our patients showed clinical improvement objectified by the Mi ller score, by the clinical stage (Crosser), and by the pulmonary arte ry mean pressure (PAPm), The treatment regimen was unsuccessful if the clinical history lasted more than 3 days. Complications occurred in 1 0 patients (34%), and 3 patients (10%) died of acute right heart failu re. Conclusion: The success of rtPA treatment appears to depend on the interval between onset of symptoms and start of thrombolytic therapy. Otherwise the technique leads to objectifiable improvement within 6 h r with an acceptable bleeding risk.