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- W1995580928 abstract "Recent studies have suggested that treating intermediate risk, acute pulmonary embolism (PE) patients with fibrinolytics reduces hemodynamic complications at a cost of increased bleeding risk. Use of a patient-specific dose of fibrinolytic may improve therapeutic index. The long-range goal is to identify a biomarker of native plasma resistance to fibrinolysis. Test if plasma from patients with intermediate risk PE has intrinsic resistance to fibrinolysis catalyzed by tissue plasminogen activator (tPA). This was a secondary analysis of plasma from patients reported in a published, randomized control trial of intermediate risk PE patients with no contraindications to fibrinolysis (TOPCOAT). Citrated plasma, obtained from 76 patients with submassive PE prior to injection of study drug, was compared with plasma from 20-age and sex-matched controls without PE. Fibrinogen, antiplasmin, plasminogen, thrombin-activated fibrinolysis inhibitor (TAFI) and D-dimer were quantified using commercially available assays. Clotting was induced using CaCl2, tissue factor, and phospholipid followed by 60 ng/mL tPA. Time to 50% clot lysis (CLT50) was assessed by turbidity (A405) and thromboelastography (TEG). Pearson’s R2 was used to test for correlation. Compared with controls, patients with PE exhibited a mean CLT50 increase of 43 min (95% CI 23 to 62 min). 18.4% of patients with submassive PE had CLT50≥180 min. Results were similar with the turbidimetric technique. CLT50 was weakly positively correlated with antiplasmin using both turbidity (R2=0.0961, P<0.01) and TEG (R2=0.042, P<0.05) measurements. No significant correlation was found between CLT50, plasminogen, fibrinogen, TAFI or D-dimer concentration. Patients with intermediate risk PE eligible for fibrinolysis have a high rate of resistance to fibrinolysis with tPA. Among five biomarkers tested, only the plasma concentration of antiplasmin was weakly predictive of this resistance." @default.
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- W1995580928 date "2014-10-01" @default.
- W1995580928 modified "2023-09-26" @default.
- W1995580928 title "43 Resistance to Clot Lysis in Patients With Submassive Pulmonary Embolism" @default.
- W1995580928 doi "https://doi.org/10.1016/j.annemergmed.2014.07.068" @default.
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