Safety of low-dose prolonged infusion of tissue plasminogen activator therapy in patients with thromboembolic events in the intensive care unit.

Mehmet Emin Kalkan,Ahmet Cagri Aykan,Yasemin Ozsahin,Mustafa Yildiz,Dogac Oksen,Hicaz Zencirkiran Agus,Hulya Yilmaz Ak

doi:10.18087/cardio.2020.7.n1091

Abstract

Objective Thromboembolic events such as acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary artery embolism and renal artery embolism are a rare condition but a major cause of morbidity and mortality. In this study we discussed low-dose thrombolytic therapy, in patients with thromboembolic events in the intensive care unit.Methods The study was performed on 12 consecutive patients [8 female; 50.3±16.0 (35-95) years] with acute thromboembolism including acute coronary syndrome related prosthetic heart valve thrombosis, acute pulmonary embolism and acute renal embolism who were treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. We evaluated mainly in-hospital safety and also effectiveness.Total treatment episodes was 1.66±0.88 (1-4) times.Results All thromboembolic events have been successfully treated with low-dose (25 mg) and slow infusion (6 hours) of t-PA. The success criteria were clinically improvement and radiologically lysis. None of the patients had ischemic stroke, intracranial hemorrhage, embolism (peripheral and recurrence of coronary artery embolism), bleeding requiring transfusion. The most frequent in-hospital complication was a gum bleeding without need for transfusion (two patients).Conclusions In our case series low-dose (25 mg) and slow infusion (6 hours) of t-PA have been performed successfully for thromboembolic events including acute coronary syndrome related prosthetic heart valve thrombosis, pulmonary embolism and renal embolism in patients with in the intensive care unit. Safety is promising and if efficacy will be proved; this method may be a valuable alternative to standard fibrinolytic regimen.

Highlights

Thromboembolic events such as acute coronary syndrome (ACS) associated with prosthetic heart valve thrombo sis, pulmonary embolism (PE) and renal embolism are rare conditions, they appear to be a major cause of morbidity and mortality
To minimise thromboembolic events and haemorrhagic complications due to high and rapid dose of thrombolytics, we previously suggested low-dose (25 mg) and slow infusion (6 hours) of tissue plasminogen activator (t-PA) for prosthetic heart valve disease [4,5,6,7,8,9]
We discuss mainly safety of thrombolytic therapy, low-dose (25 mg) and slow infusion (6 hours) of t-PA, in patients with thromboembolic events including ACS associated with prosthetic heart valve thrombosis, PE and renal artery embolism in the intensive care unit

Summary

Introduction

Thromboembolic events such as acute coronary syndrome (ACS) associated with prosthetic heart valve thrombo sis, pulmonary embolism (PE) and renal embolism are rare conditions, they appear to be a major cause of morbidity and mortality. Usually at high dose and rapid infusion, is recommended as a therapy option in this case [1,2,3] This regimen may lead to some thromboembolic and haemorrhagic complications in the intensive care unit. To minimise thromboembolic events and haemorrhagic complications due to high and rapid dose of thrombolytics, we previously suggested low-dose (25 mg) and slow infusion (6 hours) of tissue plasminogen activator (t-PA) for prosthetic heart valve disease [4,5,6,7,8,9]. We discuss mainly safety of thrombolytic therapy, low-dose (25 mg) and slow infusion (6 hours) of t-PA, in patients with thromboembolic events including ACS associated with prosthetic heart valve thrombosis, PE and renal artery embolism in the intensive care unit

Methods

Results

Discussion

Conclusion