Efficacy and Safety of Low-Dose Versus Standard-Dose Alteplase to Treat High-Risk Pulmonary Embolism.

Sustained hemodynamic stability within 24 hours did not differ significantly between low-dose and standard-dose alteplase.

• Achieved in 32% of the low-dose (50 mg) group and 38% of the standard-dose (100 mg) group; P = .65.
• Retrospective cohort analysis of 65 patients who received alteplase for high-risk pulmonary embolism at a large academic medical center between June 1, 2011, and August 31, 2022.
• Patients were assigned to cohorts according to the initial alteplase dose.

In-hospital mortality was similar between the low-dose and standard-dose groups.

• Mortality was 48% in the low-dose group vs 45% in the standard-dose group; P = .81.
• In-hospital mortality was a secondary outcome.

Patients receiving low-dose alteplase had fewer days of mechanical ventilation than those receiving standard-dose alteplase.

• Median/mean duration was 1.5 days in the low-dose group vs 6 days in the standard-dose group; P = .03.
• Duration of mechanical ventilation was a secondary outcome.

Major bleeding was numerically less frequent with low-dose alteplase, but the difference was not statistically significant.

• Major bleeding occurred in 12% of the low-dose group vs 25% of the standard-dose group; P = .34.
• Major bleeding was a secondary safety outcome.

The authors concluded low-dose alteplase may be an appropriate alternative dosing strategy for high-risk pulmonary embolism.

• Conclusion is based on no significant difference in the primary outcome of sustained hemodynamic stability within 24 hours.
• Secondary outcomes also included hospital and ICU length of stay, which were prespecified alongside mortality, ventilation duration, and bleeding.