Clot busters for pulmonary embolism trial#

We use the 2 hour extended infusion in submassive PE as there is less evidence for the bolus-dosing regimen in this setting.Īs always, thank you for your time and for tuning in. We also have the option of giving a 100 mg dose (10 mg bolus followed by 90 mg over 2 hours) if the critical care team chooses.

Clot busters for pulmonary embolism trial#

In the setting of submassive PE, we use the “MOPETT” trial dosing of a 10 mg bolus followed by 40 mg over 2 hours. This makes administration of alteplase in this scenario easier, as alteplase comes in 50 and 100 mg vials, so we can quickly draw up the bolus dose and have the nurse administer it as an IV push. Patient’s weighing < 70 kg get the 0.6 mg/kg dose as an IV bolus. “Massive PE” is defined as sustained hypotension (SBP /= 50 kg, and a weight based dose of 0.5 mg/kg (as a 10 mg bolus and the remainder given over 2 hours) in patients weighing /= 70 kg, we give 50 mg of alteplase as a bolus, which we can repeat in 15-30 minutes if needed. Per the American Heart Association, a “submassive PE” is defined as an acute PE without systemic hypotension, but with either right ventricular dysfunction or myocardial necrosis. To begin, we first have to define some terms. Next week, we will wrap it up by discussing the use of these agents in the setting of cardiac arrest.

I will not be discussing catheter-direct thrombolysis or embolectomy. In part 1 of 2 of our “clot-busters” Mini-Grand Rounds series, we start by looking at thrombolytic agents used in the setting of pulmonary embolism (PE). In both settings, t-PA can be repeated in 15-30 minutes

– In the setting of submassive PE, we give a 10 mg bolus, followed by a 40 mg infusion as bolus-dosing of t-PA has not been heavily studied in this setting. – Massive PE is defined as PE causing pulselessness, hypotension (SBP /= 70 kg, and to use a dose of 0.6 mg/kg (with a max of 50 mg) for patients weighing < 70 kg “‘Clot Busters’: Submassive and massive pulmonary embolism (PE)”: