Safety and Efficacy of Reduced-Dose Versus Full-Dose Alteplase for Acute Pulmonary Embolism: A Multicenter Observational Comparative Effectiveness Study*
Authors' conclusion
In a retrospective, PS-weighted observational study, when compared with the full-dose, reduced-dose alteplase results in similar outcomes but fewer hemorrhagic complications.
Study context
- Population
- Hospitalised patients with PE treated with systemic alteplase; tertiary care hospital and 15 community and academic centres of a large healthcare system
- Participants
- 186 vs 98
- Exposure
- Reduced-dose vs full-dose systemic alteplase
- Reduced-dosen = 186
- Full-dosen = 98reference
- Outcome
- Hemorrhagic complications
Methodological detailsmulticentre, propensity-score weighted, comparative effectiveness
- Multicentre
- Propensity-score weighted
- Comparative effectiveness
Main finding
As reported in the abstract
P = 0.014
Observational data: associations, not effects.
Further findings
Hemodynamic and respiratory variables after alteplase
- Significant improvements in shock index, BP, heart rate, respiratory rate and supplemental oxygen requirements in both groups
Mortality, discharge destination, ICU or hospital LOS, readmission (propensity score (PS)-weighted)
- No significant differences after PS weighting
- Propensity score weighted
Safety
Hemorrhagic complications · most were minor · unweighted cohort
P = 0.014
Major extracranial hemorrhage
- Major extracranial hemorrhage, reduced- vs full-dose (p = 0.022)
- 1.1% versus 6.1%
- Unweighted cohort
Hemorrhagic complications and major extracranial hemorrhage after PS weighting
- Hemorrhagic complications, reduced- vs full-dose, PS-weighted (p = 0.12)
- 15.4% vs. 24.7%
- Major extracranial hemorrhage, reduced- vs full-dose, PS-weighted (p = 0.067)
- 1.3% vs. 7.1%
- Propensity score weighted
- Differences persisted but did not reach statistical significance
Factors associated with complications
- Supratherapeutic heparin anticoagulation
- 37.5%
- Invasive procedures
- 31.3%
Original publication
Safety and Efficacy of Reduced-Dose Versus Full-Dose Alteplase for Acute Pulmonary Embolism: A Multicenter Observational Comparative Effectiveness Study*. Crit Care Med. Published 3 January 2024. doi:10.
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