Tuberculosis and Respiratory Diseases

  • 제66권1호
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  • Pages.6-12
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  • 2009
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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중증 폐혈전색전증 환자에서 Urokinase와 Alteplase의 효과 및 출혈 합병증 비교

The Therapeutic Efficacy and the Bleeding Complications of Urokinase and Alteplase in Patients with Massive Pulmonary Thromboembolism

  • 유정완 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원영 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 최창민 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Yoo, Jung-Wan (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Wongyoung (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Chang Min (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Yeon Mok (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shim, Tae Sun (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Do (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Dong Soon (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won Dong (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2008.10.23
  • 심사 : 2009.01.09
  • 발행 : 2009.01.30
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초록

연구배경: 폐혈전색전증 환자에서 혈전용해제의 효과는 차이가 없는 것으로 보고되어 있으나 출혈 등의 부작용에 대해서는 잘 알려져 있지 않다. 본 연구는 한 병원에서 중증 폐혈전색전증환자들에 사용한 alteplase와 urokinase의 치료효과 및 출혈 유발 정도를 비교하였다. 방법: 2000년 1월부터 2008년 7월까지 대상 환자 40명을 urokinase군(16명)과 alteplase군(24명)으로 나누어 의무기록을 후향적으로 분석하였다. 결과: 혈전용해제 사용한 이유는 혈역학적 불안정 23명, 중증 우심실부전 7명 그리고 헤파린 사용에도 불구하고 진행하는 저산소증 10명이었다. 두 군간 나이, APACHE II, SOFA score, 혈전용해제에서 유의한 차이는 없었다. 혈전용해제를 사용 후 승압제의 사용기간에서 aletplase군이 urokinase군보다 더 짧았으나, 인공호흡기 사용 기간과 중환자실 입원기간에서는 양 군간 유의한 차이가 없었다. 입원기간 동안 사망한 환자수는 13명(30%)으로 urokinase와 alteplase군 5명, 8명으로 유의한 차이는 없었고, 폐혈전색전증과 연관된 사망한 환자수에서도 urokinase와 alteplase군에서 1명, 4명으로 유의한 차이는 없었다. 혈전용해제 사용 후 수술적 치료가 필요한 환자 수도 urokinase군 2명, alteplase군 1명으로 차이가 없었다. 혈전용해제 사용 후 발생한 출혈은 14명(35%)에서 관찰되었고 urokinase군 3명(7.5%), alteplase군 11명(27.5%)으로 urokinase군에서 적은 경향을 보였다. 중증 출혈은 2명으로 모두 alteplase군에서 발생하였으며 1명은 뇌출혈로 사망하였다. 결론: 중증 폐색전혈전증환자에서 urokinase 사용은 alteplase에 비하여 치료효과는 차이가 없으면서 출혈의 위험은 낮을 것으로 사료된다.

Background: The efficacy of several thrombolytic agents for treating massive pulmonary thromboembolism (PTE) has been reported to be similar. However, the difference of the bleeding complications caused by two commonly used thrombolytic agents in PTE patients is not well known. The aim of this study was to compare the therapeutic efficacy and the bleeding complications between urokinase and recombinant tissue-type plasminogen activatior (rt-PA, alteplase) in a Korean medical center. Methods: We retrospectively reviewed the clinical data of the patients who were treated with thrombolytic agents (urokinase and alteplase) because of massive PTE. Results: A total of 40 patients were included: 16 (40%) treated with urokinase and 24 (60%) with alteplase. The patients treated with alteplase showed a shorter duration of using vasopressor agents than did the patients who were given urokinase, but the duration of mechanical ventilation, the length of the ICU stay and the hospital stay were not different between the thrombolytic agents. Five patients treated with urokinase and eight patients treated with alteplase died (p=0.565): One patient in the urokinase group and four patients in the alteplase group died due to pulmonary thromboembolism. Bleeding complications after thrombolysis were observed in 3 patients (7.5%) treated with urokinase and in 11 (27.5%) patients treated with alteplase (p=0.079). Major bleeding complication occurred in 2 patients who were treated with alteplase. Conclusion: Urokinase seems to have fewer bleeding complications with an equivalent efficacy, as compared to alteplase, in Korean patients who suffer with massive pulmonary thromboembolism.

키워드

참고문헌

  1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353:1386-9 https://doi.org/10.1016/S0140-6736(98)07534-5
  2. Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997;30:1165-71 https://doi.org/10.1016/S0735-1097(97)00319-7
  3. Hamel E, Pacouret G, Vincentelli D, Forissier JF, Peycher P, Pottier JM, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: results from a 128-patient monocenter registry. Chest 2001;120:120-5 https://doi.org/10.1378/chest.120.1.120
  4. Thabut G, Thabut D, Myers RP, Bernard-Chabert B, Marrash-Chahla R, Mal H, et al. Thrombolytic therapy of pulmonary embolism: a meta-analysis. J Am Coll Cardiol 2002;40:1660-7 https://doi.org/10.1016/S0735-1097(02)02381-1
  5. Capstick T, Henry MT. Efficacy of thrombolytic agents in the treatment of pulmonary embolism. Eur Respir J 2005;26:864-74 https://doi.org/10.1183/09031936.05.00002505
  6. Goldhaber SZ, Kessler CM, Heit J, Markis J, Sharma GV, Dawley D, et al. Randomized controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 1988;2:293-8
  7. Goldhaber SZ, Kessler CM, Heit JA, Elliott CG, Friedenberg WR, Heiselman DE, et al. Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: a randomized controlled multicenter trial. J Am Coll Cardiol 1992;20:24-30 https://doi.org/10.1016/0735-1097(92)90132-7
  8. Meyer G, Sors H, Charbonnier B, Kasper W, Bassand JP, Kerr IH, et al. Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: a European multicenter double-blind trial. The European Cooperative Study Group for Pulmonary Embolism. J Am Coll Cardiol 1992;19:239-45 https://doi.org/10.1016/0735-1097(92)90472-Y
  9. Scientific Committee for National Survey of Acute Pulmonary Thromboembolism, Korean Academy of Tuberculosis and Respiratory Disease. The national survey of acute pulmonary thromboembolism in Korea. Tuberc Respir Dis 2003;54:5-14
  10. Carlbom DJ, Davidson BL. Pulmonary embolism in the critically Ill. Chest 2007;132:313-24 https://doi.org/10.1378/chest.06-1854
  11. Kim SI, Park HB, Lee SY, Hyon MS. Treatment of massive pulmonary embolism with urokinase during surgery for femur fracture. Korean J Anesthesiol 2000;39:447-52 https://doi.org/10.4097/kjae.2000.39.3.447
  12. Han SY, Song JK, Lee SD, Lim CM, Koh Y, Park CS, et al. Comparison of effect between thrombolysis and anticoagulation in major pulmonary thromboembolism. Tuberc Respir Dis 2005;59:487-96 https://doi.org/10.4046/trd.2005.59.5.487
  13. Meyer G, Gisselbrecht M, Diehl JL, Journois D, Sors H. Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism. Am J Med 1998;105:472-7 https://doi.org/10.1016/S0002-9343(98)00355-6
  14. Mikkola KM, Patel SR, Parker JA, Grodstein F, Goldhaber SZ. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J 1997;134:69-72 https://doi.org/10.1016/S0002-8703(97)70108-X

피인용 문헌

  1. Short-Term Mortality in Patients with Massive and Submassive Pulmonary Embolism Receiving Thrombolytic Therapy vol.84, pp.1, 2009, https://doi.org/10.3904/kjm.2013.84.1.62