Comparison of urokinase and reteplase thrombolytic treatment in patients with high‑risk pulmonary embolism

Zhang,Yi; Ma,Lan; Fu,Qi; Zhao,Tao; Yan,Rui‑Ying; Su,Xing

doi:10.3892/etm.2019.8153

Comparison of urokinase and reteplase thrombolytic treatment in patients with high‑risk pulmonary embolism

Authors:
- Yi Zhang
- Lan Ma
- Qi Fu
- Tao Zhao
- Rui‑Ying Yan
- Xing Su
View Affiliations

Affiliations: Department of Internal Medicine, Weinan Hospital of Traditional Chinese Medicine, Weinan, Shaanxi 714000, P.R. China, Department of Intensive Care Unit, Weinan Central Hospital Affiliated to Shaanxi University of Chinese Medicine, Weinan, Shaanxi 714000, P.R. China, Department of Pharmacy, Weinan Central Hospital Affiliated to Shaanxi University of Chinese Medicine, Weinan, Shaanxi 714000, P.R. China
Published online on: October 31, 2019 https://doi.org/10.3892/etm.2019.8153
Pages: 4804-4810
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Thrombolytic treatment is recommended for patients with high‑risk pulmonary embolism. The present study compared thrombolytic therapy with urokinase and reteplase. A total of 37 patients presenting with acute high‑risk pulmonary embolism at the Intensive Care Unit of Weinan Central Hospital of Shaanxi Province (Weinan, China) between June 2013 and January 2017 were retrospectively analyzed. According to their treatment, these subjects were assigned to the reteplase group (n=16) or the urokinase group (n=21). Systolic blood pressure (SBP), heart rate (HR) and respiratory rate (RR) were recorded prior to, and at 2, 4, 24 and 48 h after thrombolytic therapy. Complications, including bleeding, were closely monitored. Changes in blood gas analysis, troponin‑T (TNT), pro‑B‑type natriuretic peptide (pro‑BNP) and D‑dimer (D‑D) were observed. In the reteplase and urokinase group, 11 and 13 cases exhibited marked improvement, treatment was rated as effective in 4 and 6 cases, and 1 and 2 mortalities occurred, resulting in an overall effective rate of 93.8 and 90.5%, respectively (P>0.05). In the reteplase group, one patient was unsuccessfully resuscitated and died. In the urokinase group, one patient died of gastric hemorrhage after 22 h of thrombolysis, while another patient died of brain failure resuscitation. The treatment improved the SBP in each of the two groups (P<0.05), and this outcome was similar between these two groups (P>0.05). HR and RR were similar prior to and after thrombolytic therapy (P>0.05). In contrast to the urokinase group, TNT was significantly decreased after thrombolyis compared with the baseline in the reteplase group. Complications in the reteplase group were higher, but in contrast to the urokinase group, no life‑threatening bleeding occurred. Although reteplase is as effective as urokinase in treating high‑risk pulmonary embolism, reteplase may reduce myocardial damage.

View Figures

View References

1	Meyer G: Effective diagnosis and treatment of pulmonary embolism: Improving patient outcomes. Arch Cardiovasc Dis. 107:406–414. 2014. View Article : Google Scholar : PubMed/NCBI
2	Chalikias G and Konstantinides S: Acute phase treatment of pulmonary embolism. Curr Vasc Pharmacol. 12:393–400. 2014. View Article : Google Scholar : PubMed/NCBI
3	Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R, McBane RD, Moll S and Ansell J: Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis. 41:32–67. 2016. View Article : Google Scholar : PubMed/NCBI
4	Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G and Perrier A: Systemic thrombolytic therapy for acute pulmonary embolism: A systematic review and meta-analysis. Eur Heart J. 36:605–614. 2015. View Article : Google Scholar : PubMed/NCBI
5	Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, Naidu S and Oklu R: Deep vein thrombosis: Pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 7 (Suppl 3):S276–S284. 2017. View Article : Google Scholar : PubMed/NCBI
6	Marcos-Contreras OA, Ganguly K, Yamamoto A, Shlansky-Goldberg R, Cines DB, Muzykantov VR and Murciano JC: Clot penetration and retention by plasminogen activators promote fibrinolysis. Biochem Pharmacol. 85:216–222. 2013. View Article : Google Scholar : PubMed/NCBI
7	Sadowski M, Ząbczyk M and Undas A: Coronary thrombus composition: Links with inflammation, platelet and endothelial markers. Atherosclerosis. 237:555–561. 2014. View Article : Google Scholar : PubMed/NCBI
8	Smalling RW, Bode C, Kalbfleisch J, Sen S, Limbourg P, Forycki F, Habib G, Feldman R, Hohnloser S and Seals A: More rapid, complete, and stable coronary thrombolysis with bolus administration of reteplase compared with alteplase infusion in acute myocardial infarction. RAPID Investigators. Circulation. 91:2725–2732. 1995. View Article : Google Scholar : PubMed/NCBI
9	Rosenberg DG, Levin E, Lausell A, Brown A, Gardner J, Perez E, Veenendaal M, Ong YS and Gunn M: Feasibility and timing of prehospital administration of reteplase in patients with acute myocardial infarction. J Thromb Thrombolysis. 13:147–153. 2002. View Article : Google Scholar : PubMed/NCBI
10	Morrow DA, Antman EM, Sayah A, Schuhwerk KC, Giugliano RP, deLemos JA, Waller M, Cohen SA, Rosenberg DG, Cutler SS, et al: Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: Results of the early retavase-thrombolysis in myocardial infarction (ER-TIMI) 19 trial. J Am Coll Cardiol. 40:71–77. 2002. View Article : Google Scholar : PubMed/NCBI
11	Luiz T, Wilhelms A, Madler C, Pollach G, Haaff B, Grüttner J and Viergutz T: Outcome of out-of-hospital cardiac arrest after fibrinolysis with reteplase in comparison to the return of spontaneous circulation after cardiac arrest score in a geographic region without emergency coronary intervention. Exp Ther Med. 13:1598–1603. 2017. View Article : Google Scholar : PubMed/NCBI
12	Adivitiy a and Khasa YP: The evolution of recombinant thrombolytics: Current status and future directions. Bioengineered. 8:331–358. 2017. View Article : Google Scholar : PubMed/NCBI
13	Lippi G, Mattiuzzi C and Favaloro EJ: Novel and emerging therapies: Thrombus-targeted fibrinolysis. Semin Thromb Hemost. 39:48–58. 2013.PubMed/NCBI
14	Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, et al: Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the American Heart Association. Circulation. 123:1788–1830. 2011. View Article : Google Scholar : PubMed/NCBI
15	Pulmonary Circulation and Right Ventricular Function Assembly of Chinese Society of Cardiology of Chinese Medical Association: Chinese expert consensus on the diagnosis and management of acute pulmonary embolism (2015). Zhonghua Xin Xue Guan Bing Za Zhi. 44:197–211. 2016.(In Chinese). PubMed/NCBI
16	Simpson D, Siddiqui MA, Scott LJ and Hilleman DE: Reteplase: A review of its use in the management of thrombotic occlusive disorders. Am J Cardiovasc Drugs. 6:265–285. 2006. View Article : Google Scholar : PubMed/NCBI
17	Department of Pulmonary Vascular Diseases, Chinese Medical Association Cardiovascular Disease: Chinese expert consensus on the diagnosis and management of acute pulmonary embolism. Chin J Intern Med. 49:74–81. 2010.(In Chinese).
18	Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs J, Huisman MV, Humbert M, Kucher N, et al: Authors/task force members. corrigendum to: 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 36:26422015. View Article : Google Scholar : PubMed/NCBI
19	Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, et al: ESC committee for practice guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: The task force for the diagnosis and management of acute pulmonary embolism of the European society of cardiology (ESC). Eur Heart J. 29:2276–2315. 2008.PubMed/NCBI
20	Bloomer TL, El-Hayek GE, McDaniel MC, Sandvall BC, Liberman HA, Devireddy CM, Kumar G, Fong PP and Jaber WA: Safety of catheter-directed thrombolysis for massive and submassive pulmonary embolism: Results of a multicenter registry and meta-analysis. Catheter Cardiovasc Interv. 89:754–760. 2017. View Article : Google Scholar : PubMed/NCBI
21	Daley MJ, Murthy MS and Peterson EJ: Bleeding risk with systemic thrombolytic therapy for pulmonary embolism: Scope of the problem. Ther Adv Drug Saf. 6:57–66. 2015. View Article : Google Scholar : PubMed/NCBI
22	Long B and Koyfman A: Current controversies in thrombolytic use in acute pulmonary embolism. J Emerg Med. 51:37–44. 2016. View Article : Google Scholar : PubMed/NCBI
23	Nagamalesh UM, Prakash VS, Naidu KCK, Sarthak S, Hegde AV and Abhinay T: Acute pulmonary thromboembolism: Epidemiology, predictors, and long-term outcome-A single center experience. Indian Heart J. 69:160–164. 2017. View Article : Google Scholar : PubMed/NCBI
24	Goldhaber SZ, Kessler CM, Heit J, Markis J, Sharma GV, Dawley D, Nagel JS, Meyerovitz M, Kim D and Vaughan DE: Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet. 2:293–298. 1988. View Article : Google Scholar : PubMed/NCBI
25	Mannu GS: The non-cardiac use and significance of cardiac troponins. Scott Med J. 59:172–178. 2014. View Article : Google Scholar : PubMed/NCBI
26	Olson JD: D-dimer: An overview of hemostasis and fibrinolysis, assays, and clinical applications. Adv Clin Chem. 69:1–46. 2015. View Article : Google Scholar : PubMed/NCBI
27	Liu XY, Zhang Y, Li MW, Wang XP, Qi DD, Hao PY, Zhang H, Cheng QQ, Zhao LS, Gao CY and Hu DY: Efficacy of thrombolytic therapy using reteplase in cases with acute ST-segment elevation myocardial infarction: Results from a multicenter clinical trial. Zhonghua Xin Xue Guan Bing Za Zhi. 44:766–770. 2016.(In Chinese). PubMed/NCBI