Use of rt-PA for pulmonary embolism

The Bottom Line: Neither mortality due to PE nor objective PE recurrence are decreased by rt-PA compared with heparin in patients with hemodynamically stable PE.There is no benefit suggested in studies including patients with right ventricular dysfunction alone.

Tardy, B Short term effect of recombinant tissue plasminogen activator in patients with hemodynamically stable acute pulmonary embolism: results of a meta-analysis involving 464 patients. Thrombosis research 2009 vol:124 iss:6 pg:672 -677

To date, a short IV infusion of recombinant tissue Plasminogen Activator seems to be one of the best choices among the different thrombolytic agents and regimen modalities. To clarify the potential role of thrombolytic therapy in PE, the authors performed an updated meta-analysis of randomized trials comparing intravenous rt-PA and heparin in the treatment of only hemodynamically stable acute pulmonary embolism. Additionally, as patients with hemodynamically stable PE and echocardiographic evidence of right ventricular dysfunction could have a higher mortality than those without RVD. Tthe effect of rt-PA therapy compared to heparin, in this subset of patients was also studied.

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