• Kimberly Brandt, Kaitlin McGinn, and Jeffrey Quedado.
• Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA St Joseph's Regional Medical Center, Paterson, NJ, USA gathersk@sjhmc.org.
• Ann Pharmacother. 2015 Jul 1; 49 (7): 818-24.

ObjectiveTo review and evaluate the evidence regarding the use of low-dose regimens of alteplase (tPA) for the treatment of pulmonary embolism (PE).Data SourcesA PubMed search (1966-January 2015) was conducted using the search terms pulmonary embolism, drug therapy, thrombolytic therapy, fibrinolytic agents, and tissue plasminogen activator. Articles were cross-referenced for additional citations.Study Selection And Data ExtractionClinical trials and case reports published in the English language assessing the use of low-dose systemic tPA for the treatment of PE were reviewed for inclusion.Data SynthesistPA is a thrombolytic agent indicated for the treatment of massive and submassive PE. Major bleeding complications of tPA are dose dependent and may occur in up to 6.4% of patients. Clinical trials have demonstrated safety and efficacy of low-dose tPA, particularly showing its benefit in patients with a low body weight (<65 kg) and right-ventricular dysfunction. Furthermore, case reports have safely used lower doses of tPA in patients at higher risk of bleeding, including elderly, pregnant, and surgical patients.ConclusionsThe available data suggest that low-dose tPA may be a safe and effective treatment option for acute PE, particularly in patients at a high risk of bleeding. More studies are needed to determine the optimal dosing regimen of tPA for PE.© The Author(s) 2015.

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