Jemds.com Original Research Article J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 8/ Issue 34/ Aug. 26, 2019 Page 2681 Improvement in Clinical Outcomes, Right Ventricular Function and Pulmonary Artery Hypertensions after Half Dose Thrombolysis in Patients with High Risk Sub-Massive Pulmonary Thromboembolism Ramalingam Vadivelu 1 , Nagendra Boopathy Senguttuvan 2 , Ravindran Rajendran 3 , Kathiresan Jeyashree 4 , Anand Subramanian 5 , Vinod Kumar B. 6 , Ramesh S. 7 , Muralidharan T. R. 8 1 Assistant Professor, Department of Cardiology, Velammal Medical College and Hospital, Madurai, Tamilnadu, India. 2 Assistant Professor, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu, India. 3 Assistant Professor, Department of Cardiology, Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamilnadu, India. 4 Assistant Professor, Department of Community Medicine, Velammal Medical College and Hospital, Madurai, Tamilnadu, India. 5 Consultant Interventional Cardiologist, Department of Cardiology, Kauvery Hospitals, Trichy, Tamilnadu, India. 6 Assistant Professor, Department of Cardiology- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu, India. 7 Assistant Professor, Department of Cardiology- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu, India. 8 HOD, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu, India. ABSTRACT BACKGROUND Role of fibrinolysis in sub-massive pulmonary thromboembolism (PTE) is not clear. Improved hemodynamics with increased bleeding with fibrinolysis in patients with high risk sub massive PTE when compared to anticoagulation alone without mortality benefit is known. METHODS We retrospectively studied the effect of low dose fibrinolysis in patients with submassive pulmonary thromboembolism in four centers over a period of two years. Submassive PTE is defined as major PTE with RV dysfunction and myocardial injury (elevated troponin) but without cardiogenic shock. Baseline pre- thrombolysis assessment of clinical parameters and hemodynamics of the patient, RV function assessment with TAPSE, RV Fractional Area Change (FAC) and Pulmonary Artery Pressure (PAP) were assessed and all the readings were repeated post thrombolysis. RESULTS A total of 123 patients was screened, out of which, 72 patients (58%) had sub massive pulmonary thromboembolism. Out of 72 patients, 11 (15%) patients who had been treated with low dose fibrinolysis for varied reasons were included in the study. Mean ± SD age of the study population was 58.36±10.20 years with 54.5% of them being males. Deep vein thrombosis was a predisposing factor in 7 patients (63%). CONCLUSIONS LDF is feasible, effective and safe in patients with high risk submassive PTE who had at least intermediate risk for bleeding. In almost all patients except in one, RV function improved, and PA pressure reduced significantly. We propose that a similar tailored approach in patients with PTE may improve the clinical outcomes with better safety profile. KEY WORDS Pulmonary Thromboembolism, Fibrinolysis, Pulmonary Artery Hypertension, RV Function Corresponding Author: Dr. Nagendra Boopathy Senguttuvan, Assistant Professor and Senior Consultant Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai-600116, Tamilnadu, India. E-mail: drsnboopathy@gmail.com DOI: 10.14260/jemds/2019/583 Financial or Other Competing Interests: None. How to Cite This Article: Vadivelu R, Senguttuvan NB, Rajendran R, et al. Improvement in clinical outcomes, right ventricular function and pulmonary artery hypertensions after half dose thrombolysis in patients with high risk sub- massive pulmonary thromboembolism. J. Evolution Med. Dent. Sci. 2019;8(34): 2681-2686,DOI: 10.14260/jemds/2019/583 Submission 05-07-2019, Peer Review 11-08-2019, Acceptance 17-08-2019, Published 26-08-2019.