The Therapeutic Efficacy and the Bleeding Complications of Urokinase and Alteplase in Patients with Massive Pulmonary Thromboembolism

Jung-Wan Yoo; Wongyoung Kim; Chang Min Choi; Sang-Bum Hong; Yeon Mok Oh; Tae Sun Shim; Chae-Man Lim; Sang Do Lee; Woo Sung Kim; Dong Soon Kim; Won Dong Kim; Younsuck Koh

doi:10.4046/trd.2009.66.1.6

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Yoo, Kim, Choi, Hong, Oh, Shim, Lim, Lee, Kim, Kim, Kim, and Koh: The Therapeutic Efficacy and the Bleeding Complications of Urokinase and Alteplase in Patients with Massive Pulmonary Thromboembolism

Original Article

Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(1): 6-12.

Published online: 31 January 2009

DOI: https://doi.org/10.4046/trd.2009.66.1.6

The Therapeutic Efficacy and the Bleeding Complications of Urokinase and Alteplase in Patients with Massive Pulmonary Thromboembolism

Jung-Wan Yoo, M.D., Wongyoung Kim, M.D., Chang Min Choi, M.D., Sang-Bum Hong, M.D., Yeon Mok Oh, M.D., Tae Sun Shim, M.D., Chae-Man Lim, M.D., Sang Do Lee, M.D., Woo Sung Kim, M.D., Dong Soon Kim, M.D., Won Dong Kim, M.D., Younsuck Koh, M.D.

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Younsuck Koh, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3134, Fax: 82-2-3010-6968, yskoh@amc.seoul.kr

Received 23 October 2008 Accepted 9 January 2009

Abstract

Background

The efficacy of several thrombolytic agents for treating massive pulmonary thromboembolism (PTE) has been reported to be similar. However, the difference of the bleeding complications caused by two commonly used thrombolytic agents in PTE patients is not well known. The aim of this study was to compare the therapeutic efficacy and the bleeding complications between urokinase and recombinant tissue-type plasminogen activatior (rt-PA, alteplase) in a Korean medical center.

Methods

We retrospectively reviewed the clinical data of the patients who were treated with thrombolytic agents (urokinase and alteplase) because of massive PTE.

Results

A total of 40 patients were included: 16 (40%) treated with urokinase and 24 (60%) with alteplase. The patients treated with alteplase showed a shorter duration of using vasopressor agents than did the patients who were given urokinase, but the duration of mechanical ventilation, the length of the ICU stay and the hospital stay were not different between the thrombolytic agents. Five patients treated with urokinase and eight patients treated with alteplase died (p=0.565): One patient in the urokinase group and four patients in the alteplase group died due to pulmonary thromboembolism. Bleeding complications after thrombolysis were observed in 3 patients (7.5%) treated with urokinase and in 11 (27.5%) patients treated with alteplase (p=0.079). Major bleeding complication occurred in 2 patients who were treated with alteplase.

Conclusion

Urokinase seems to have fewer bleeding complications with an equivalent efficacy, as compared to alteplase, in Korean patients who suffer with massive pulmonary thromboembolism.

Keywords: Pulmonary thromboembolism, Thrombolysis, Bleeding complication

Figures and Tables

Table 1

Baseline characteristics of patients with thrombolysis

rt-PA: recombinant tissue type plasminogen activator; BMI: body mass index; DVT: deep vein thrombosis; APACHE II score: acute physiology and chronic health evaluation II score; SOFA score: sequential organ failure assessment score.

Table 2

Systolic/diastolic blood pressure and laboratory findings in patients

PF ratio: PaO₂/FiO₂; BNP: B-type natriuretic peptide.

Table 3

Dose of thrombolytic agents in 40 patients

IVB: intravenous bolus; IVI: intravenous infusion.

Table 4

Duration of mechanical ventilation, intensive care unit, hospital stay and use of vasopressor

Data are presented as days.

ICU: intensive care unit.

Table 5

Duration of mechanical ventilation, intensive care unit, hospital stay and use of vasopressor (only hemodynamically unstable)

Data are presented as days.

ICU: intensive care unit.

Table 6

The number of therapeutic response, in-hospital and pulmonary thromboembolism associated death

PTE: pulmonary thrmboembolism.

Table 7

Number of patients with bleeding complications

NS: not significant.

^*Compartment syndrome at right upper extremity was developed due to the bleeding at the initial arterial puncture site in the emergency room.

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