Comparative Analysis Of Half Dose Rt-PA And Standard Dose Rt-PA In The Treatment Of Acute Pulmonary Embolism With Thrombolytic Therapy:A Meta-analysis

Objective:the efficacy and safety of 50 mg rt-PA(test group)and 100 mg rt-PA(control group)in the treatment of acute pulmonary embolism(PE)patients who need to thrombolytic therapy,in order to obtain a more optimal dosage regimen of rt-PA thrombolytic therapy;Methods:We searched The Cochrane Library,Pubmed,EMBASE,CNKI,VIP and Wan Fang Literature Database from January 1990 to December 2016 for randomized controlled trials(RCT)focusing on low dose rt-PA for acute PE.Outcomes were described in terms of changes of Pulmonary systolic pressure(s PAP),Activated partial thromboplastin time(APTT),Fibrinogen,Plasma fibrin degradation products(FDP),bleeding events,mortality,and recurrence of PE.Results: Nine studies(740 patients)were included,which compared 50 mg rt-PA with 100 mg rt-PA.Compared with the control group,after 2 hours of thrombolysis,the pulmonary artery systolic test group decreased significantly(MD=-5.93,95%CI(-6.49,-5.37),P < 0.00001),There were more major bleeding events in standard dose rt-PA group than in low dose group(OR 0.33,95%CI 0.12-0.91;P =0.94,I2 = 0%);Plasma fibrinogen(p=0.007)was higher than that of control groupand plasma fibrin degradation products were lower than those of control group(P=0.013).Bleeding complications: the incidence of fatal hemorrhage in the experimental group was lower than that in the control group(OR 0.23,95%CI:0.11-0.47),There was significant difference between the two groups(P < 0.0001);Minor bleeding rate in experimental group was lower than the control group(OR0.35,95%CI:0.23-0.54),The difference was statistically significant(P < 0.00001);there were no statistical differences in cure rate(OR0.93,95%CI : 0,54-1.60,P=0.79)or all cause mortality between these two groups.The recurrence rate of experimental group was lower than the control group,the two groups with(OR0.5,95%CI:0.27-0.95),the difference was statistically significant(P<0.03).There was no significant difference in the mortality rate was lower than that of the control group(OR0.8,95%CI:0.33-1.92,P<0.62).Conclusions:To consider the clinical safety,efficacy and reduce the economic burden of patients,The application of 50 mg rt-PA of thrombolytic therapy for acute pulmonary embolism Could acquired more risk-benifitial rate.However,due to the influence of many factors,such as body weight,time of administration,and the number of cases,the conclusions of this article are for reference only,can not be directly concluded,more similar clinical trials need to be further confirmed...