Comparison of urokinase and

Thrombolytic treatment in patients

reteplase
withHigh risk pulmonary embolism
Yi ZHANG, LAN MA, QI FU, TAO ZHAO, RUI-YING YAN AND XING SU

Presented by:
Muhammad Riza Qadafi, R
S.Ked

Supervisor :
dr. Haris Munirwan,Sp.JP

CARDIOLOGY DEPARTMENT
MEDICAL FACULTY OF UNIVERSITAS ABULYATAMA
 Introductio
n
2 Thrombus from
The venous system
Pulmonary circulation Respiratory dysfunction
dysfunction

Pulmonary
Thromboembolism ( PTE)

The third most common cause of death

Among patients with Cardiovascular disease
 Thrombolytic agents
( Fibrinolytics}
3
Alteplase Urokinase
Reteplase Streptokinase
Tenecteplase Anistreplase

Reteplase Urokinase

Smaller derivate Produced

of recombinant naturally in the
TPA kidneys
 Prothrombin
4 Complex
Prothrombin thrombin Plasmin

Degradation
Fibrinogen Fibrin
Products
Plasmin

Degradation
Products

Plasminogen Plasmin
tPA
Urokinase
 The purpose of the
study
5

“The aim of the study was to compare the

effectiveness of reteplase with urokinase
in treating high-risk pulmonary embolism”
 MATERIALS AND
METHODS
6
Patients and Data
All patients who were rescued by Intensive Care Unit of Weinan
Central Hospital of Shaanxi Province between June 2013 and
January with high-risk pulmonary embolism were selected for
analysis in the present study

The Criteria for inclusion

1. Adult Patients diagnosed with high-risk PTE
2. Patients who underwent intravenous reteplase or
urokinase
7 The Criteria for Exclusion
1. > 2 weeks after disease onset
2. Incomplete data set
3. Contraindications for thrombolytic treatment
4. Other forms of thrombolytic therapy
5. Severe cardiovascular disease or cerebrovascular

Statistic Analysis
1. Kolmogorov smirnov
2. T-test
3. Chi-Square
4. Anova
 Therapeutic metods

8 Reteplase Urokinase

18 mg reteplase was diluted in Urokinase for injection 20.000

20 ml saline and iv administered U/kg was diluted in 40 ml
for 10 min, another dose 18 mg saline and intravenously
administered after 30 min pumped over 2 h

Examined every 4 h Examined every 4 h

If aPTT dropped to twice

heparin calcium 0,1 ml/10kg
9
Urokinase for injection
18 mg reteplase was diluted in
20 ml saline and iv administered
20.000 U/kg was diluted in
for 10 min, another dose 18 mg 40 ml saline and
administered after 30 min intravenously pumped
over 2 h
 RESULTS.

10
”
 MAJOR CAUSES OF
PULMONARY
11 EMBOLISM

▹ Trauma and Bed Rest after Surgery (62,2%)

▹ Hypertension (8,1%)
▹ Diabetes (8,1%)
▹ Cerebral Infarction (5,4%)
▹ Coronary Heart Disease (5,4%)
▹ Lower Extremity Varicose Vein (10,8%)
12
13
14
15
 DISCUSSION

16
 When Is pulmonary
embolsim occur ??
17
Pulmonary embolism is
occur when a detaced
thrombus from any part of
the venous territory becomes
lodgeg in the pulmonary
artery
 Let’s Discuss
18

Retaplase and urokinase

achieved good effects by The use of reteplase
rapidly improving the was suggested may
patient’s subjective reduce and prevent
symptoms and stabilizing Myocardial damage
their hemodynamics
19 The Two groups exhibit high levels of effectiveness and there was no
significant difference between reteplase and urokinase

TNT continued to exhibit an upward trend after therapy with Urokinase,

and declined with reteplase, therefore reteplase suggesting may be better
for improving myocardial damage

Complications of bleeding increased after treatmen in the reteplase

group, but not fatal bleeding occurred. One patient with urokinase
developed GI Bleeding and died
 LIMITATION
20
▹ The small sample size result from single center nature
▹ The study was retrospective in nature
▹ No echocardiographic data for all patient
▹ The patient were not followed up after discharge