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fibrinolysis in pulmonary embolism for all type of patients, clinical trials results

desmoteplase versus alteplase
Tebbe, 2009
125, 180, and 250 microg/kg bodyweight desmoteplase
versus
100 mg alteplase
acute massive pulmonary thromboembolismNA
half-dose t-PA versus no fibrinolysis
MOPETT, 2012
half-dose thrombolysis
versus
standard regimen of anticoagulants alone
patients presenting with moderate PEopen
Follow-up duration: 28 months
rt-PA versus no fibrinolysis
PAIMS 2, 1992
rt-PA 100 mg IV over 2 h and heparin
versus
Heparin 1750 IU/hr i.v. for 7 to 10 days
patients with angiographically documented pulmonary embolismopen
Follow-up duration: 7 days
Italy
Goldhaber, 1993
rt-PA 100 mg IV over 2 h then 1000 U/hr heparin,when PTT or TT was < 2 times control. Subsequent heparin dose achieved PTT = 1.5 to 2.5 times the upperlimit of normal.
versus
heparin, initial dose 5000 U bolus followed by 1000 U/hr continuous i.v., 4 hr after the dose of heparin according to PTT. Target PTT = 1.5 to 2.5 times of normal
haemodynamically stable patients with acute pulmonary embolismopen
Follow-up duration: 14 days
US
rt-PA versus placebo
Konstantinides, 2002
100 mg alteplase given as 10 mg bolus followed by 90 mg i.v. infusion over 2 hours then i.v. heparin 1000 U/hr adjusted to maintain APTT of 2.0 to 2.5times the upper normal limit. Oral anticoagulation was started on day 3
versus
placebo + i.v. heparin 1000 U/hr adjusted to maintain APTT of 2.0 to 2.5times the upper normal limit. Oral anticoagulation was started on day 3
patients with acute pulmonary embolism and pulmonary hypertensionor right ventricular dysfunction but withoutarterial hypotension or shockdouble blind
Follow-up duration: <30 days
Germany
PIOPED, 1990
rt-PA 40–80 mg IV over 90 min plus heparin
versus
placebo+heparin
patients with acute pulmonary embolismdouble blind
Follow-up duration: 7 days
US
Levine, 1990
rt-PA 0.6 mg/kg IV over 2 min and heparin, initial bolus of 5000 U, then 30,000 U for first 24 hr continuous infusion,only interrupted for the duration of the study drug infusion
versus
placebo + heparin bolus of 5000 U, then 30,000 U for first 24 hr continuous infusion
patients with objectively established acute symptomatic pulmonary embolismdouble blind
Follow-up duration: 10 days
Canada
streptokinase versus no fibrinolysis
Tibbutt, 1974
intrapulmonary SK 600,000-U bolus, then 100,000 U/h for 72 h and intrapulmonary heparin
versus
5000U heparin plus 100mg hydrocortisone infused over 30 mins through pulmonary artery catheter. Followed by 2500 U for 72 hr
life-threatening pulmonary embolismopen
Follow-up duration: 3 days
UK
Ly, 1978
streptokinase 250,000-U bolus, then 100,000 U/h for 72 h and heparin
versus
Heparin 15,000 IU initial dose i.v. followed by 30,000 IU/day continuous i.v., adjusted by TT
patients with major pulmonary embolism verified by angiographyopen
Follow-up duration: 10 days
Norway
Jerjes-Sanchez, 1995
streptokinase 1,500,000 U IV over 1 h and heparin
versus
heparin alone
high clinical suspicion for massive pulmonary embolismopen
Follow-up duration: 3 days
urokinase versus no fibrinolysis
Marini, 1988
urokinase 800,000 U/d IV for 72 h, UK 3,300,000 U IV for 12 h and heparin
versus
heparin
patients with pulmonary embolismopen
Follow-up duration: 7 days
urokinase versus placebo
UPET, 1973
urokinase 2,000-U/lb bolus, then 2,000 U/lb per h IV for 12 h and heparin
versus
placebo + Heparin (a loading dose of 75 U/pound, then 10 U/pound/hr for 12 hr infusion, then heparin for a minimum of 5 days, followed by heparin or warfarin therapy for a total of 14 days)
patients with pulmonary embolismdouble blind
Follow-up duration: <14 days
US

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