Thrombolytische Behandlung der akuten und subakuten rezidivierenden Lungenembolie mit rekombinantem Gewebe-Plasminogenaktivator

Abstract

Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) at a dosage of 40-150 mg was given to five patients with acute and five with recurrent pulmonary emboli (three women and seven men; mean age 54 [30-78] years). Mean pulmonary artery pressure fell from 29 +/- 7 mm Hg before to 20 +/- 5 mm Hg after treatment (P = 0.001), and in recurrent emboli from 47 +/- 19 to 18 +/- 10 mm Hg (P = 0.01). Pulmonary vascular resistance fell from 546 +/- 262 to 318 +/- 116 dyn.s.cm-5 (P = 0.02) in the former group and from 993 +/- 583 to 377 +/- 438 dyn.s.cm-5 (P = 0.01) in the latter. Pulmonary arteriograms were assessed using the Miller index. This indicated a drop from an average of 23 points before to an average of 10.5 points after treatment. Mild bleedings occurred in all patients, but in two it was severe enough to require discontinuation of treatment. These results demonstrate that rt-PA is highly effective as a thrombolytic agent in acute and in subacute recurrent pulmonary embolism.