Literature review of the safety and efficacy of recombinant tissue-type plasminogen activator in the pulmonary embolism patients with pregnancy

Abstract

Objective To explore the safety and efficacy of recombinant tissue-type plasminogen activator (rtPA) and to do the literature case review Methods The related data-bases were searched. The literatures about treatment for pregnant women with pulmonary embolism by rtPA was collected. The patients′basic information, the situation of fibrinolytic therapy (including type, dosage, and usage of rtPA, and the outcomes of fibrinolytic therapy), the occurrence of ADR, and the outcomes of pregnancy were recorded. A descriptive statistical analysis for the above-mentioned results was performed. Results Reports involving 16 patients were enrolled into the study, 15 papers in English and 1 in Chinese. The average age of the 16 patients were (32±6) years (21-40 years). The numbers of cases in early, interim, and late stage of pregnancy were 6 (37.5%), 4 (25.0%) and 6 (37.5%), respectively. The patient′clinical manifestations included shock (11 cases), chest pain (8 cases), dyspnea (8 cases), syncope (2 cases), with blood pressure 67-122/40-87mmHg, heart rate 106-158 beats/min, and oxyhemoglobin saturation 79%-96%. The number of patients who were diagnosed as acute pulmonary embolism by color doppler echocardiography, pulmonary ventilation and perfusion scan, and spiral CT pulmonary arteriography were 13, 6 and 2, respectively. Fifteen patients received ateplase for fibrinolytic therapy, among them 14 cases′dosages were 41-100 mg/2.0-4.5 hours, another patient had no record of dosage. One patient received monteplase for fibrinolytic therapy, the dosage was 1 600 000 U/2 hours. The route of administration was intravenous injection. After 14 days of fibrinolytic therapy, a patient died of recurrent pulmonary embolism. The other patients′all clinical manifestations disappeared. Four patients (25%) had bleeding after fibrinolytic therapy. Two of the 4 patients presented with vaginal bleeding during childbirth, the amount of bleeding were 8 900 ml and 2 238 ml, respectively. Their vaginal bleeding was stopped after the blood transfusion therapy. The other 2 of the 4 patients had bleeding at puncture site and nose, respectively. The bleeding was stopped after 48 hours by local compression. The outcome of pregnancy showed that 13 of the 16 pregnant woman delivered live births including one case of premature delivery and placental abruption. Two of the other three of the 16 pregnant women underwent voluntary induction of labor in early pregnancy and one had abortion due to dead fetus in uterus after 28 weeks of pregnancy. There was a live-born infant who died from acute respiratory distress syndrome on 14th day after birth in 13 live-born infants. Conclusion Treatment with rtPA for thrombolytic therapy is effective and relatively safe for the pregnant women with pulmonary embolism. Key words: Plasminogen activators; Pulmonary embolism; Pregnancy; Thromboiltic therapy