Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial).
Research article published in The American journal of cardiology (2012)
Abstract
The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this "safe dose" thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a "safe dose" of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p <0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p <0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG (p <0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a "safe dose" thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that "safe dose" thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator.
Why This Matters for Hirudotherapy
The MOPETT trial randomized 121 patients with moderate pulmonary embolism to a low ("safe") dose of tissue plasminogen activator plus anticoagulation versus anticoagulation alone, reporting that the composite of pulmonary hypertension and recurrent PE developed in far fewer thrombolysis-group patients (16% vs 63%, p<0.001), shorter hospitalization, fewer combined death/recurrent-PE events, and no bleeding in either group. For ASH it is a clinically meaningful demonstration that fibrinolytic (clot-dissolving) therapy can improve outcomes in venous thromboembolism — the same fibrinolytic principle embodied by leech-secretome enzymes such as destabilase, which is studied for its ability to lyse fibrin and which anchors part of the leech-derived drug-discovery narrative. Honest caveat: MOPETT is a single, relatively small open-label randomized trial of a conventional thrombolytic drug (alteplase), not of any leech-derived agent, and its no-bleeding result comes from a modest sample that larger studies would need to confirm; ASH cites it only as supportive context for the fibrinolysis concept, drawing no equivalence to leech therapy.
Citation
Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial).
Sharifi M et al. · The American journal of cardiology, 2012
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