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

Author:

Kalkan Mehmet Emin1ORCID,Yildiz Mustafa2ORCID,Ak Hulya Yilmaz3,Zencirkiran Agus Hicaz1,Ozsahin Yasemin3,Aykan Ahmet Cagri4,Oksen Dogac3

Affiliation:

1. University of Health Sciences Turkey, Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery Educational and Research Hospital, Istanbul, Turkey

2. University of Health Sciences Turkey, Mehmet Akif Ersoy Cardiovascular and Thoracic Surgery Educational and Research Hospital, Istanbul, Turkey Istanbul University-Cerrahpasa Cardiology Institute, Istanbul, Turkey

3. Istanbul University-Cerrahpasa Cardiology Institute, Istanbul, Turkey

4. Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey

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.

Publisher

APO Society of Specialists in Heart Failure

Subject

Cardiology and Cardiovascular Medicine

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