Photo Credit: Mr. Suphachai Praserdumrongchai

The following is a summary of “Safety and Efficacy of Reduced-Dose Versus Full-Dose Alteplase for Acute Pulmonary Embolism: A Multicenter Observational Comparative Effectiveness Study*,” published in the May 2024 issue of Critical Care by Melamed et al.

While systemic alteplase is effective for pulmonary embolism (PE), its bleeding risk necessitates exploring the safety and efficacy of lower doses.

Researchers conducted a retrospective study comparing outcomes and bleeding risks in patients with PE receiving full-dose versus reduced-dose alteplase.

They conducted a multicenter retrospective observational study involving a tertiary care hospital and 15 community and academic centers within an extensive healthcare system. The study focused on hospitalized patients with PE who received systemic alteplase treatment.

The results showed comparisons between pre- and post-alteplase hemodynamic and respiratory variables, patient outcomes, and complications. The PS weighting was utilized to adjust imbalances in baseline characteristics between reduced- and full-dose patients. Separate analyses were conducted on unweighted and weighted cohorts. About 98 patients received full-dose (100 mg), while 186 received reduced-dose (50 mg) regimens. Both groups exhibited significant improvements in various parameters post-alteplase. Reduced-dose regimen showed lower hemorrhagic complications compared to full-dose (13% vs. 24.5%, P=0.014), mostly minor. Major extracranial hemorrhage incidence was 1.1% vs. 6.1% respectively (P=0.022). Complications were linked to supratherapeutic levels of heparin anticoagulation in 37.5% of cases and invasive procedures in 31.3%. Differences in complications persisted after PS weighting (15.4% vs. 24.7%, P=0.12 and 1.3% vs. 7.1%, P=0.067) but were not statistically significant. No significant differences were observed in mortality, discharge destination, ICU or hospital length of stay, or readmission after PS weighting.

Investigators concluded that a propensity score-weighted analysis suggests reduced-dose alteplase for PE achieves similar outcomes with less bleeding, but minimizing high heparin levels and invasive procedures is crucial for further complication reduction.

Source: journals.lww.com/ccmjournal/abstract/2024/05000/safety_and_efficacy_of_reduced_dose_versus.5.aspx