LOW DOSE VS HIGH DOSE RECOMBINANT TISSUE-TYPE PLASMINOGEN ACTIVATOR FOR THE TREATMENT OF ACUTE PULMONARY THROMBOEMBOLISM: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: A 2-hour infusion of 100 mg recombinant tissue plasminogen activator (rtPA) is approved by the US Food and Drugs Administration (FDA) for eligible patients with acute pulmonary embolism (PE). However, multiple clinical trials showed that a lower dosage of rtPA (0.6 mg/kg, maximum of 50 mg) is equally effective and associated with a potentially lower complication rate than the 100 mg regimen. We conducted a systematic review and meta-analysis to compare the two regimens. METHODS: We conducted a systematic search of the PubMed, EMBASE, and Cochrane databases from inception through January-2020 for studies comparing high dose rtPA (100 mg) and low dose rtPA (0.6 mg/kg, maximum of 50 mg) for the treatment of acute pulmonary embolism. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The random-effects model was used for all variables, and publication bias was assessed using Egger’s test. RESULTS: Five studies (four prospective and one retrospective) published between 1994 and 2017 examining 422 patients were included in our analysis. The outcomes of these studies looked at complications, including all bleeding events, major bleeding events, all-cause mortality, intracranial bleeding, and recurrence of PE. We found low dose rtPA to be associated with less bleeding events in general than high dose rtPA with odds ratio of 0.49 (95% CI 0.28 to 0.86) (I²=0.00%). Our analysis showed no significant differences in major bleeding events and intracranial bleeding events between the two populations with odds ratios of 0.52 (95% CI 0.23 to 1.17) (I²=0.00%) and 0.49 (95% CI 0.03 to 1.62) (I²=0.00%) respectively after stratifying for bleeding events. Also, no significant differences were observed between the two regimens with respect to all-cause mortality and pulmonary embolism recurrence with odds ratios of 0.95 (95% CI 0.38 to 2.38) (I²=0.00%) and 0.71 (95% CI 0.27 to 1.85) (I²=0.00%) respectively. CONCLUSIONS: Our results showed that low dose rtPA might be superior to high dose rtPA with regards to all bleeding events. However, no significant differences in major bleeding events, all-cause mortality, intracranial bleeding, and recurrence of PE were found between the two regimens. CLINICAL IMPLICATIONS: Although low dose rtPA might be as effective as high dose rtPA in the treatment of acute pulmonary embolism, our analysis suggests no significant differences between the two regimens in terms of major bleeding events, intracranial bleeding events, and all-cause mortality. DISCLOSURES: No relevant relationships by Adel El Abbassi, source=Web Response No relevant relationships by Mahmoud El Iskandarani, source=Web Response No relevant relationships by Ibrahim Haddad, source=Web Response No relevant relationships by Sajin Karakattu, source=Web Response No relevant relationships by ANAS SAMMAN, source=Web Response