Pulmonary Embolism Clinical Trial
Official title:
Low Dose Rt-PA Plus LMWH Compared With LMWH Alone for the Treatment of Normotensive Pulmonary Embolism Patients With Acute RV Dysfunction: A Randomized,Multi-Center,Controlled Trial
In selected patients with acute pulmonary embolism(PE), low dose (50mg/2h) recombinant tissue plasminogen activator (rt-PA) regimen had been reported to have less bleeding tendency than the FDA-approved rt-PA 100mg/2h regimen 100mg/2h regimen (3% vs.10%), it is worthwhile to reveal whether low dose rt-PA plus low molecular weight heparin (LMWH) can rapidly reverses RV pressure overload in PE, but not increase bleeding and other adverse events. The aim of the study is to compare thrombolytic treatment with LMWH in patients with acute normotensive PE with right ventricular dysfunction(RVD).
In acute pulmonary embolism (PE), normotensive patients with acute RV dysfunction on
echocardiography or computed tomography and with myocardial troponin elevation may have an
adverse outcome. Thrombolysis rapidly reverses RV pressure overload in PE, but it increases
the possibility of bleeding and it remains unclear whether it may improve the early or
long-term clinical outcome of these selected normotensive patients.
In our previous study, we found that low dose (50mg/2h) recombinant tissue plasminogen
activator (rt-PA) regimen had less bleeding tendency than the 100mg/2h regimen (3% vs.10%),
it is worthwhile to reveal whether low dose rt-PA plus Low Molecular Weight Heparin (LMWH)
can rapidly reverses RV pressure overload in PE, but not increase bleeding and other adverse
events.
In this prospective, multicenter, randomized, control study, we compare low dose rt-PA plus
LMWH vs. LMWH alone in acute normotensive pulmonary embolism patients with RV dysfunction.
The primary efficacy outcome is the composite of death from any cause or treatment failure,
improvements of right ventricular functions on echocardiogram and pulmonary artery
obstruction on CT angiographs within 7 days of randomization. Second efficacy outcome is the
recurrence of pulmonary embolism and deep venous thrombosis. Safety outcomes include serious
life threatening bleeding such as cerebral hemorrhage and other major bleeding episodes,
also include mild bleeding. In addition, 90-day clinical and echocardiographic follow-up
will be performed, the recurrence of pulmonary embolism and deep venous thrombosis will be
recorded. The study is expected to enroll approximately 460 patients.
By determining the benefits vs risks of Low dose rt-PA plus LMWH compared with LMWH alone
for the treatment in submassive or intermediate-risk PE, this trial is expected to reveal
the worth of Low dose rt-PA plus LMWH treatment and what kind of PE patients are suitable
for thrombolysis.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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