Outcomes of systemic thrombolysis with reteplase in high-risk acute pulmonary embolism

Leila Bigdelu; Mahla Deldar; Asal Yadollahi; Vafa Baradaran Rahimi

doi:10.1515/jbcpp-2024-0188

Article

Outcomes of systemic thrombolysis with reteplase in high-risk acute pulmonary embolism

Leila Bigdelu , Mahla Deldar , Asal Yadollahi and Vafa Baradaran Rahimi

Published/Copyright: April 16, 2025

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From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 36 Issue 2-3

Abstract

Objectives

High-risk pulmonary embolism (PE) is known as the presence of hemodynamic instability and has a high mortality rate, which necessitates immediate reperfusion treatment. According to current PE treatment guidelines, alteplase is the approved and preferred agent for systemic thrombolysis. Herein, we present the efficacy and safety of systemic thrombolysis with reteplase in patients with high-risk PE.

Methods

The present retrospective observational study includes 30 patients with high-risk acute PE undergoing systemic thrombolysis with reteplase. All patients were in obstructive shock. The thrombolytic regimen consisted of two bolus doses of 10 U reteplase, given 30 min apart, followed by intravenous heparin.

Results

All patients had elevated cardiac troponin levels. D-dimer levels were elevated in 28 (93.3 %) patients. Systolic blood pressure increased after thrombolysis with reteplase, and the dyspnea, tachypnea, and coughing improved in all patients. Mean SPO₂ was 83.6 ± 6.96 % before treatment, which had risen to 95.7 ± 1.29 % after thrombolysis (p=0.059). Right ventricular dilatation was seen in all patients at presentation, which improved by 96.6 % after treatment and systolic pulmonary artery pressure decreased significantly in all patients at discharge. None of the patients needed to repeat thrombolytic therapy. There were no major hemorrhagic complications or death after thrombolysis, while 5 (16.7 %) patients experienced minor self-limiting bleeding.

Conclusions

Reteplase, as two bolus injections of 10 U given 30 min apart, is an effective thrombolytic regimen in treating acute high-risk PE with a low risk of major hemorrhagic complications.

Keywords: high-risk pulmonary embolism; thrombolysis; reteplase

Corresponding authors: Asal Yadollahi, MD, and Vafa Baradaran Rahimi, PharmD, PhD, Assistant Professor, Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Sq., Vakil Abad Highway, Mashhad, 9177948564, Iran, E-mail: YadollahiA@mums.ac.ir (A. Yadollahi), vafa_br@yahoo.com (V. Baradaran Rahimi)

Funding source: Islamic Azad University, Mashhad Branch

Award Identifier / Grant number: 111200651954341398162255750

Research ethics: We collected the data from hospital records and kept them in an electronic file with an anonymous identification number for each case. This study complies with the principles outlined in the Declaration of Helsinki, and the study was approved by the Ethics committee of Mashhad Islamic Azad University (N: IR.IAU.MSHD.REC.1400.015).
Informed consent: Not applicable.
Author contributions: Leila Bigdelu: Conceptualisation, Methodology, Supervision, Funding Acquisition, Writing – review & editing; Mahla Deldar: Investigation, Data Curation; Asal Yadollahi: Investigation, Writing – Original Draft, Writing – review & editing, Vafa Baradaran Rahimi: Investigation, Formal Analysis, Writing – review & editing.
Use of Large Language Models, AI and Machine Learning Tools: Not applicable.
Conflict of interest: None.
Research funding: Funding for this research was provided by the Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University (111200651954341398162255750).
Data availability: The data sets used for the current study are available from the corresponding author upon reasonable request.

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Received: 2024-10-07

Accepted: 2025-03-22

Published Online: 2025-04-16

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Articles in the same Issue

https://doi.org/10.1515/jbcpp-2024-0188

Keywords for this article

high-risk pulmonary embolism; thrombolysis; reteplase