Half-Dose Alteplase Is Associated with Escalation of Care in Pulmonary Embolism Patients

Thrombolysis for patients with pulmonary embolism (PE) remains controversial. Taking on risk for hemorrhage to resolve potential shock for patients with massive PEs seems reasonable, but the risk-benefit decision making is more challenging for patients with submassive PEs. Clinicians have considered using half-dose alteplase in these situations, with the hope of attenuating this risk.

Investigators retrospectively reviewed data on nearly 3800 patients with PEs who had received either half-dose (699 patients) or full-dose (3069 patients) alteplase, given intravenously at 420 hospitals. One third of patients were receiving vasopressors when alteplase was administered; one quarter, mostly full-dose patients, were supported by mechanical ventila…