Effect of rt-PA dose on pulmonary artery pressure and bleeding volume during ultrasound-assisted catheter thrombolysis in patients with moderate- to high-risk acute pulmonary embolism

doi:10.3877/cma.j.issn.1674-6902.2026.01.007

Abstract

Abstract:

Objective

To analyze the effects of recombinant tissue plasminogen activator (rt-PA) dosage on pulmonary artery pressure and bleeding risk during ultrasound-assisted catheter-directed thrombolysis (UACDT) in patients with intermediate- to high-risk acute pulmonary embolism (PE).

Methods

This retrospective study included 42 patients with intermediate-to-high-risk acute pulmonary embolism (PE) treated with UACDT at our hospital from February 2020 to December 2024. Patients were divided into two groups based on their cumulative rt-PA dose: 21 patients with rt-PA ≤ 24 mg were in the control group, and 21 patients with rt-PA > 24 mg were in the observation group. The cumulative rt-PA dose, changes in systolic pulmonary artery pressure (sPAP), and postoperative complications were recorded during treatment. Right ventricular pressure load and hemodynamic parameters, including sPAP, mean pulmonary artery pressure (mPAP), and diastolic pulmonary artery pressure (dPAP), were compared between the two groups. The relationship between cumulative rt-PA dose and postoperative bleeding risk was analyzed.

Results

The mean treatment time for UACDT was (61.89±28.76) h, and the cumulative rt-PA was (43.28±30.03) mg. sPAP showed a decreasing trend with increasing cumulative rt-PA (F=12.451, P<0.001). In the control group, after treatment, 10 cases (47.62%) had normal right ventricular load, 9 cases (42.86%) had mild right ventricular load, 1 case (4.76%) had moderate right ventricular load, and 1 case (4.76%) had severe right ventricular load (P<0.001). In the observation group, after treatment, 14 cases (66.67%) had normal right ventricular load, 7 cases (33.33%) had mild right ventricular load, and there were no moderate or severe cases (P<0.001). After treatment, sPAP, mPAP, and dPAP in both groups decreased compared to before treatment (P<0.05). After treatment, the sPAP (43.10±4.90)mmHg, mPAP (23.10±3.20)mmHg, and dPAP (17.60±2.70)mmHg in the observation group were lower than those in the control group (sPAP (49.80±5.40)mmHg, mPAP (26.70±3.80)mmHg, and dPAP (20.70±3.10)mmHg (P<0.05). After treatment, the pulmonary vascular resistance (201.20±28.80)dyn·s·cm^-5 in the observation group was lower than that in the control group PVR (265.40±35.10)dyn·s·cm^-5 (P<0.001). The average postoperative intensive care unit (ICU) stay was (4.89±3.14) days, and the total hospital stay was (8.01±5.38) days. Complete thrombolysis was achieved in 18 cases (85.71%) in the observation group, higher than in 10 cases (48.00%) in the control group (χ²=6.886, P=0.032); the average thrombus burden score was (2.41±0.68) points, higher than in the control group (1.85±0.72) points (t=3.66, P<0.001). Complete effectiveness was achieved in 18 cases (85.71%) in the observation group, higher than in 11 cases (52.38%) in the control group (P=0.048). At the end of follow-up, 37 patients (88.09%) survived, 5 patients (11.90) died, 8 patients (19.05%) experienced mild bleeding, and 1 patient (2.39%) experienced moderate bleeding.

Conclusion

UACDT treatment of intermediate-to high-risk PE patients with low-dose-rate rt-PA to prolong thrombolysis time helps improve pulmonary circulatory dynamic parameters, does not increase bleeding risk, and is well tolerated.

Key words: Acute pulmonary embolism, Recombinant tissue plasminogen activator, Ultrasound-assisted catheter-directed thrombolysis, Hemodynamic parameters

Renyuan Chang, Tao Lei, Tong Wang, Yu Chen, Zhimei Li, Xin Gao, Nan Zhou, Lei Cao, Yanfang Dong, Jingjing Liu. Effect of rt-PA dose on pulmonary artery pressure and bleeding volume during ultrasound-assisted catheter thrombolysis in patients with moderate- to high-risk acute pulmonary embolism[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 42-48.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2026.01.007

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2026/V19/I01/42

Figures/Tables 3

References 33

1	Guliani S, Gupta JD, Osofsky R, et al. Venoarterial extracorporeal membrane oxygenation is an effective management strategy for massive pulmonary embolism patients[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(2): 307-314.
2	Baran C, Kayan A, Baran CS. Algorithm of high-risk massive pulmonary thromboembolism with extracorporeal membrane oxygenation[J]. J Clin Med, 2024, 13(22): 6822.
3	陈文灯，陈敏，吴书香，等. 血清可溶性生长刺激表达基因2蛋白与急性肺栓塞并发肺动脉高压风险临床研究[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(3): 401-405.
4	Tu T, Toma C, Tapson VF, et al. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study[J]. JACC: Cardiovascul Int, 2019, 12(9): 859-869.
5	Rothschild DP, Goldstein JA, Ciacci J, et al. Ultrasound-accelerated thrombolysis (USAT) versus standard catheter-directed thrombolysis (CDT) for treatment of pulmonary embolism: a retrospective analysis[J]. Vascul Med, 2019, 24(3): 234-240.
6	Planer D, Yanko S, Matok I, et al. Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate-or high-risk pulmonary embolism: systematic review and network meta-analysis[J]. CMAJ, 2023, 195(24): E833-E843.
7	Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2012, 141(2): e419S-e496S.
8	Becattini C, Agnelli G, Lankeit M, et al. Acute pulmonary embolism：mortality prediction by the 2014 European Society of Cardiology risk stratification model[J]. Eur Respir J, 2016, 48(3): 780-786.
9	Amini S, Bakhshandeh H, Mosaed R, et al. Efficacy and safety of different dosage of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of acute pulmonary embolism: a systematic review and meta-analysis[J]. Iran J Pharm Res, 2021, 20(2): 441.
10	Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2012, 141(2): e419S-e496S.
11	Sharifi M, Awdisho A, Schroeder B, et al. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism[J]. Vascul Med, 2019, 24(2): 103-109.
12	Kiser TH, Burnham EL, Clark B, et al. Half-dose versus full-dose alteplase for treatment of pulmonary embolism[J]. Crit Care Med, 2018, 46(10): 1617-1625.
13	Bagla S, Smirniotopoulos JB, van BredaA, et al. Ultrasound-accelerated catheter-directed thrombolysis for acute submassive pulmonary embolism[J]. J Vascul Int Rad, 2015, 26(7): 1001-1006.
14	Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2020, 41(4): 543-603.
15	Gusto Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction[J]. New Engl J Med, 1993, 329(10): 673-682.
16	Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography[J]. J Am Soc Echocardiogr, 2010, 23(7): 685-713.
17	Lei M, Liu C, Luo Z, et al. Diagnostic management of inpatients with a positive D-dimer test: developing a new clinical decision-making rule for pulmonary embolism[J]. Pulmon Circulat, 2021, 11(1): 2045894020943378.
18	Ning D, Zhou L, Fu M Y, et al. Safety and efficacy of thrombolytic therapy in the treatment of early pulmonary embolism after thoracic surgery[J]. J Thorac Dis, 2024, 16(10): 6417.
19	Ferrazzini E, Méan M, Stalder O, et al. Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism[J]. Blood Adv, 2023, 7(2) 205-213.
20	Kaymaz C, Akbal OY, Tanboga I H, et al. Ultrasound-assisted catheter-directed thrombolysis in high-risk and intermediate-high-risk pulmonary embolism: a meta-analysis[J]. Current Vascul Pharmacol, 2018, 16(2): 179-189.
21	Kucher N, Boekstegers P, Müller OJ, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism[J]. Circulation, 2014, 129(4): 479-486.
22	Tapson VF, Sterling K, Jones N, et al. A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial[J]. JACC Cardiovasc Interv, 2018, 11(14): 1401-1410.
23	Klein F, Möbius-Winkler S, Bäz L, et al. EKOS™ Jena Experience：Safety, feasibility, and midterm outcomes of percutaneous ultrasound-assisted catheter-directed thrombolysis in patients with intermediate-high-risk or high-risk pulmonary embolism[J]. Canad Respir J, 2022, 2022(1): 7135958.
24	Piazza G, Hohlfelder B, Jaff MR, et al. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE Ⅱ study[J]. JACC Cardiovasc Interv, 2015, 8(10): 1382-1392.
25	Tapson VF, Sterling K, Jones N, et al. A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial[J]. JACC Cardiovasc Interv, 2018, 11(14): 1401-1410.
26	Sista AK. The OPTALYSE PE trial: another step toward understanding the truth about catheter-directed thrombolysis for submassive pulmonary embolism[J]. JACC Cardiovasc Interv, 2018, 11(14): 1411-1413.
27	Bakkum MJ, Schouten VL, Smulders YM, et al. Accelerated treatment with rtPA for pulmonary embolism induced circulatory arrest[J]. Thromb Res, 2021, 203: 74-80.
28	Elhakim A, Knauth M, Elhakim M, et al. Using a fibrinolysis delivery catheter in pulmonary embolism treatment for measurement of pulmonary artery hemodynamics[J]. Adv Respir Med, 2022, 90(6): 483-499.
29	Li HY, Wang YB, Ren XY, et al. Comparative efficacy and safety of thrombolytic agents for pulmonary embolism: a Bayesian network meta-analysis[J]. Pharmacology, 2023, 108(2): 111-126.
30	Kuo WT, Banerjee A, Kim PS, et al. Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry[J]. Chest, 2015, 148(3): 667-673.
31	Machanahalli BalakrishnaA, Reddi V, Belford PM, et al. Intermediate- risk pulmonary embolism: a review of contemporary diagnosis, risk stratification and management[J]. Medicina (Kaunas), 2022, 58(9): 1186.
32	Melamed R, St HillCA, Engstrom BI, et al. Effects of a consensus-based pulmonary embolism treatment algorithm and response team on treatment modality choices, outcomes, and complications[J]. Clin Appl Thromb Hemost, 2020, 26: 1076029620928420.
33	Antoine D, Chuich T, Mylvaganam R, et al. Relationship of left ventricular outflow tract velocity time integral to treatment strategy in submassive and massive pulmonary embolism[J]. Pulm Circ, 2020, 10(3): 2045894020953724.

例数	治疗时间(h)	累计rt-PA(mg)	sPAP (mmHg)
42	19.45±4.52	11.78±4.67	43.01±12.32
38	43.01±4.76	27.16±10.44	41.56±13.36
26	63.86±5.68	42.34±14.41	37.56±14.45
13	89.17±3.64	63.98±23.76	34.35±14.31
4	113.35±2.14	98.89±31.13	47.93±16.32
1	137.89	158.26	38.32

例数	治疗时间(h)	累计rt-PA(mg)	sPAP (mmHg)
42	19.45±4.52	11.78±4.67	43.01±12.32
38	43.01±4.76	27.16±10.44	41.56±13.36
26	63.86±5.68	42.34±14.41	37.56±14.45
13	89.17±3.64	63.98±23.76	34.35±14.31
4	113.35±2.14	98.89±31.13	47.93±16.32
1	137.89	158.26	38.32

血流动力学参数	观察组		对照组
血流动力学参数	治疗前	治疗后	治疗前	治疗后
sPAP(mmHg)	73.50±5.80	43.10±4.90	65.20±6.30	49.80±5.40
mPAP(mmHg)	35.60±3.90	23.10±3.20	33.00±4.2	26.70±3.80
dPAP(mmHg)	31.90±4.10	17.60±2.70	28.50±3.90	20.70±3.10
PVR(dyn·s·cm)	525.70±47.30	201.20±28.80	470.30±50.60	265.40±35.10

血流动力学参数	观察组		对照组
血流动力学参数	治疗前	治疗后	治疗前	治疗后
sPAP(mmHg)	73.50±5.80	43.10±4.90	65.20±6.30	49.80±5.40
mPAP(mmHg)	35.60±3.90	23.10±3.20	33.00±4.2	26.70±3.80
dPAP(mmHg)	31.90±4.10	17.60±2.70	28.50±3.90	20.70±3.10
PVR(dyn·s·cm)	525.70±47.30	201.20±28.80	470.30±50.60	265.40±35.10

[1]	Chaowen Deng, Meng Chen, Huajuan Lei, Qi Zhou, Yongjie Teng. Comparative study of nerve block and spinal-epidural combined anesthesia on hemodynamic parameters in elderly patients with indirect inguinal hernia [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(02): 130-133.
[2]	Wendeng Chen, Min Chen, Shuxiang Wu, Xiangzhen Zheng, Bin Chen, Liutong Chen. Clinical research of serum soluble growth stimulation expressed gene 2 and the risk of acute pulmonary embolism complicated with pulmonary hypertension [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(03): 401-405.
[3]	Min Ou, Bin Wang, Mingzhou Zhang, Junkang Dong, Yu Liu, Pinliang Liao, Heling Ren, Xin Jiang, Xiaolian Cai. Significance of electrocardiogram and echocardiography in the diagnosis of acute pulmonary embolism and risk stratification [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(04): 502-505.
[4]	Zhaolong Peng, Junfeng Shi, Bin Liu, Miao Yuan, Hongtian Zhang, Qiusheng Dai, Lei Yang, Chao Xu, Jialin Xu, Qiang Yu, Zhili Li, Ruxiang Xu. Comparative analysis of MSU and routine treatment of acute ischemic stroke [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(05): 277-280.
[5]	Youdong Wan, Xinting Pan, Shaoyan LYU, Lianxing Zhao, Ziqian Wu, Lei Li. Misdiagnosis of an acute aortic dissection patient with acute coronary syndrome [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(04): 373-375.
[6]	Dandan Peng, Min Wang, Jun Li, Chong Zeng, Ling Zeng, Yulian Hu. Value of cerebral hemodynamic parameters combined with hs-CRP and IL-6 in the early diagnosis of brain injury in premature infants [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(06): 352-357.
[7]	Guangdong Lu, Zhenyu Jia, Jinxing Zhang, Linbo Zhao, Haibin Shi. The establishment of acute pulmonary embolism model and the effects of CD147 expression level on the pulmonary arterial pressure in embolized rats [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 313-318.
[8]	Xiaoli Zhang, Xin Han, Kunqi Han, Shanshan Li, Xiangjing Liu, Dongcheng Xu, Lei Mou. Risk factors related to prognosis of intravenous thrombolysis with alteplase in patients with acute cerebral infarction [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(05): 338-341.
[9]	Qiming Liang, Lifei Lian, Feng Xu, Chao Pan, Suiqiang Zhu, Furong Wang. CT blend sign do not increase the risk of postoperative rebleeding in minimally invasive surgery for intracerebral hemorrhage [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(06): 361-366.
[10]	Kaikai Xie, Wenfeng Cao, Zhengbing Xiang, Shimin Liu, Wei Rao, Lingfeng Wu. The comparison of rt-PA intravenous thrombolysis and rt-PA intravenous thrombolysis combined with mechanical thrombectomy in anterior circulation stroke due to the large vessel occlusion [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2020, 14(02): 90-95.

Please choose a citation manager

Content to export