Masif pulmoner emboli hastalarında trombolitik ajan olarak kullanılan alteplaz ve reteplazın klinik etkinliğinin retrospektif değerlendirilmesi

Öz

Amaç: Masif pulmoner emboli hastalarında alteplaz ve reteplazın klinik etkinliğinin karşılaştırılması. Gereç ve Yöntemler: 2010-2016 yılları arasında masif pulmoner emboli nedeniyle trombolitik tedavi olarak alteplaz ya da reteplaz verilen tüm hastalar çalışmaya alındı. Demografik veriler, bazal, 2., 4., 6., 12., ve 24. saatteki hemodinamik parametreler, erken ve geç mortalite ile kanama komplikasyonları karşılaştırıldı. Bulgular: Yaş ortalaması 64.2±13.6 yıl olan toplam 75 hasta, (32 alteplaz, 43 reteplaz ) çalışmaya alındı. Her iki grupta da hemodinamik parametrelerde anlamlı düzelme saptandı. Sistolik kan basıncında bazal değerlere göre 6. ve 12. saatlerdeki artış alteplaz grubunda reteplaz grubundan anlamlı olarak daha yüksek bulundu. Mortalite ve majör kanama her iki grupta da benzer bulundu. Minör kanama ise alteplaz grubunda reteplaz grubuna göre anlamlı olarak daha yüksek saptandı, sırasıyla %28,1 vs %2,3. Sonuç: Masif pulmoner emboli hastalarında trombolitik tedavide reteplaz, alteplaz kadar etkin ve güvenli görünmektedir.

Anahtar Kelimeler

• Alteplaz
• doku plazminojen aktivatörü
• pulmoner emboli
• reteplaz trombolizis

Retrospective evaluation of two different thrombolytic agents in the treatment of patients with massive pulmonary embolism: Alteplase vs reteplase

Öz

Aim: To compare clinical effectiveness of reteplase and alteplase in patients with massive pulmonary embolism. Material and Methods: Between 2010 and 2016 all patients treated with one of the thrombolytic agents, alteplase or reteplase, for massive pulmonary embolism were eligible for the study. We compared demographic data, hemodynamic parameters at baseline and at 2th, 4th, 6th, 12th, 24th hours after thrombolysis, the early and 1 year mortality rates and bleeding complications between two groups. Results: Seventy five patients (32 alteplase and 43 reteplase) were included study. Mean age was 64.2±13.6 years. Compared to the baseline values, hemodynamic parameters improved significantly at 2th, 4th, 6th, 12th and 24th hours after thrombolysis in both groups. In alteplase group, systolic blood pressure between baseline and at 6th and 12th hours altered significantly when compared with reteplase group. No significant difference was found in mortality rates and major bleeding events between groups. Minor bleeding events were higher in alteplase group than reteplase group, 28.1% vs 2.3%, respectively and the difference was significant. Conclusion: Reteplase seems as safe and effective as alteplase in the thrombolytic treatment of patients with massive pulmonary embolism.

Anahtar Kelimeler

• Alteplase
• pulmonary embolism
• reteplase
• tissue plasminogen activator
• thrombolysis

Kaynakça

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