Randomised trials comparing thrombolytic and heparin therapy
| Study | Treatment regimens | No. of patients | Mortality, n (%) | Recurrence n (%) | Major haemorrhage,* n (%) | Comments | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| *Defined as intracranial bleed, bleed requiring surgery, transfusion or fall >10% in haematocrit. IV, intravenous; IP, intrapulmonary; U, units; SK, streptokinase; UK, urokinase; rTPA, recombinant tissue plasminogen activator, infusion followed by intravenous heparin. | ||||||||||||
| UPET 197020 | IV heparin v UK | 78 | 7 (8.9) | 15 (19) | 21 (27) | Patients had <5 days of symptoms | ||||||
| 2000 U/lb bolus then hourly | 82 | 6 (7.3) | 12 (15) | 37 (45) | Angiography used to diagnose and repeated at 24 hours showing improved haemodynamics in UK group | |||||||
| Tibbutt et al 197421 | IP heparin | 17 | 1 (5.8) | 1 (5.8) | 1 (5.8) | SK group had greater improvement in pulmonary perfusion | ||||||
| IP SK 600 000 units bolus then 100 000 units/h for 72 hours | 13 | 0 | 0 | 1 (8) | All patients had life threatening PE and angiographic diagnosis | |||||||
| Ly et al 197822 | IV heparin v APTT | 11 | 2 (18.2) | NA | 2 (18) | Angiographic evidence of improved perfusion with SK | ||||||
| SK 250000 units bolus and 100000 units per hour 72 hours | 14 | 1 (7.1) | 4 (29) | All patients >1 lobar artery occluded | ||||||||
| Marini et al 198823 | Heparin v APTT | 10 | 0 | 0 | 0 | Patients all >9 segments not perfused on Q scan. By 24 hrs and at 1 year no difference in pulmonary haemodynamics | ||||||
| UK 800 000 units 12 hourly for 3 days | 10 | 0 | 0 | 0 | ||||||||
| UK 3 300 000 units for 12 hours | 10 | 0 | 0 | 0 | ||||||||
| PIOPED 199024 | Heparin v APTT | 4 | 0 | NA | 0 | Vascular resistance better for rTPA group at 90 mins but equal at 2 hrs | ||||||
| rTPA 40–80 mg for 40–90 minutes | 9 | 1 (11.1) | 1 (11.1) | Patient diagnosis by angiogram | ||||||||
| Levine et al 199025 | Heparin v APTT | 25 | 0 | 0 | 0 | Perfusion scan on day 1 better with rTPA but equal by day 7 | ||||||
| rTPA 0.6 mg/kg over 2 minutes | 33 | 1 (3) | 0 | 0 | Diagnosis by angiogram | |||||||
| PAIMS 2 199226 | Heparin v APTT | 16 | 1 (6.3) | 3 (18.8) | 2 (12.5) | Haemodynamics better at 24 hours in rTPA group but equal day 7 and 30 | ||||||
| rTPA 100 mg over 2 hours | 20 | 2 (10) | 1 (5) | 3 (15) | ||||||||
| Goldhaber et al 199327 | Heparin v APTT | 55 | 2 (3.6) | 5 (9.1) | 1 (1.8) | Perfusion scans and RV function on echo better in rTPA at 24 hours | ||||||
| rTPA 100 mg over 2 hours | 46 | 0 | 0 | 2 (4.3) | ||||||||
| Jerges-Sanches et al 199528 | Heparin infusion v APTT | 4 | 4 (100) | NA | 0 | All patients had shock. 100% mortality in heparin group led to trial being abandoned early | ||||||
| SK 1 500 000 units over 1 hour | 4 | 0 | 0 | |||||||||
| Konstantinides et al 200229 | Heparin infusion v APTT | 138 | 3 (2.2) | 4 (2.9) | 5 (3.6) | Unexpectedly low mortality. Composite end point of death or treatment escalation lower in rTPA | ||||||
| rTPA 100 mg over 2 hours | 118 | 4 (3.4) | 4 (3.4) | 1 (0.8) | Group: see text. | |||||||