Antiphospholipid syndrome and renal artery stenosis.

We have arbitrarily chosen our recommended W.-K. Chan reduced dosage of thrombolytic therapy as few T.-F. Chan studies address this issue. The largest study was by Division of Cardiology Goldhaber et al.6 comparing reduced rtPA bolus Department of Medicine & Geriatrics (0.6 mg/kg/15 min, maximum 50 mg) and rtPA infuUnited Christian Hospital sion (100 mg over 2 h) in 87 patients, a double-blind Hong Kong randomized multicentre controlled trial. All patients had baseline, 20-h and 28-h follow-up nuclear scans. Some patients in centres with angiography services had baseline and 2-h pulmonary angiography, and References some patients had baseline, 3-h, 20-h and 28-h 1. Wolfgang, Konstatinides S, Geibel A. Management strategies echocardiogram. There was no significant difference and determinants of outcome in acute major pulmonary between the two regimens with respect to bleeding embolism: Results of a Multicentre Registry. J Am Coll complications, adverse clinical events, mortality and Cardiol 1997; 30:1165–71. imaging studies outcome. In a substudy in 48 2. Konstatinides S, Geibel A, Olschewski M, et al. Association patients, there was less fibrinogenolysis in the bolus between thrombolytic treatment and the prognosis of group. hemodynamically stable patients with major pulmonary embolism. Circulation 1997; 96:882–8. Another study compared rtPA and Streptokinase in 66 patients with acute massive pulmonary embol3. Mikkola KM, Goldhaber SZ, Parker JA, et al. Increasing age is a major risk factor for haemorrhage complications after ism.7 There was a more rapid improvement in total pulmonary embolism thrombolysis. Am Heart J 1997; pulmonary resistance at 1 h in the rtPA group com134:69–72. pared with the streptokinase group, but a similar 4. ACCP Consensus Committee on Pulmonary Embolism haemodynamic efficacy at 2 h when both thromOpinion regarding the diagnosis and management of Venous bolytic regimens were completed. One-year eventThromboembolis. Chest 1996; 109:233–7. free survival was similar in both groups and there 5. Kanter DS, Mikkola KM, Patel SR, Parker JA, Goldhaber SZ. was no significant difference in bleeding comThrombolytic therapy for pulmonary embolism. Frequency of plications. intracranial haemorrhage and associated risk factors. Chest Because of the small sample size of our study 1997; 111:1241–5. group, and lack of matched controls, we can draw 6. Goldhaber SZ, Agnell G, Levine MN. Reduced dose bolus no definite conclusion about the efficacy and safety ateplase against conventional ateplase infusion for pulmonary embolism thrombolysis. An international multicentre of our reduced dosage of thrombolytic therapy for randomised trial. The Bolus Ateplase Pulmonary Embolism acute massive pulmonary embolism in Chinese eldgroup. Chest 1994; 106:718–24. erly patients. However, we believe that the weight7. Meneveau N, Schiele F, Metz D, et al. Comparative efficacy adjusted reduced dosage is appropriate for this group of a two-hour regimen of Streptokinase versus alteplase in of patients in whom the bleeding complications will acute massive pulmonary embolism: immediate clinical and be higher. A large multicentre trial is needed to hemodynamic outcome and one year follow up. J Am Coll Cardiol 1998; 31:1057–63. address this issue.