SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters I
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Acute massive pulmonary embolus (AMPE, pulmonary embolism with shock) has high mortality rate. The 2012 ACCP Consensus Statement on Antithrombotic Therapy recommends intravenous thrombolysis for treatment of AMPE. Tenecteplase (TNK) is a newer generation recombinant plasminogen activator with a 15-fold increase in fibrin specificity, longer half-life, fewer dosing errors and fewer major bleeding complications as compared with alteplase. Data regarding use of TNK for AMPE are limited and little information exists regarding utility of a clinical protocol for AMPE management.
METHODS: A multi-specialty workgroup (Critical Care Medicine, Emergency Medicine and Pharmacology) developed a computerized clinical protocol for use of TNK in AMPE. We performed an IRB-approved, retrospective review to assess clinician protocol adherence, safety, and efficacy. Statistical significance was established at p< 0.05.
RESULTS: Sixteen patients received TNK for AMPE at our institution between January 2010 and December 2011. Median age was 65 years (23-83 years) and 69% were female. AMPE was diagnosed by CTPA (44%), echocardiography (50%), or clinical grounds (6%). Median time from presentation to diagnosis was 60 minutes. Cardiac arrest was observed in 56% with a median time from diagnosis of 23 minutes. Presenting symptoms (dyspnea, 94%; chest/back pain, 75%; and syncope, 25%), medical comorbidities, vital signs and laboratory data did not predict cardiac arrest or mortality. Protocol adherence was observed in 94% of cases. Hospital mortality was 63% with an AMPE attributable mortality of 50%. TNK hemorrhagic complications were minor in 17% and major in 17% but did not result in any deaths.
CONCLUSIONS: Our study showed high adherence to the protocol. Patients with AMPE frequently had rapid progression to cardiac arrest. The presenting history, symptoms and signs did not predict mortality. Complications from TNK therapy were relatively minor. Major hemorrhage was observed less frequently than reported with alteplase.
CLINICAL IMPLICATIONS: Thrombolysis for massive PE can be successfully administered with high fidelity through use of a standardized clinical protocol. TNK may have fewer bleeding complications than alteplase in AMPE and further investigation is warranted.
DISCLOSURE: The following authors have nothing to disclose: Jennifer Palminteri, Anne Andrle, Kathryn Smith, Joel Wirth
No Product/Research Disclosure InformationMaine Medical Center, Portland, ME