Objective:To investigate the clinical efficacy of alteplase combined with heparin in the treatment of acute moderate- and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level.Methods:Seventy-eight patients with acute moderate- and high-risk pulmonary thromboembolism who received treatment in Dongyang People's Hospital from January 2015 to January 2022 were retrospectively included in this study. They were divided into observation ( n = 39) and control ( n = 39) groups according to different treatment methods. The control group was treated with heparin, while the observation group was treated with alteplase based on heparin. All patients were treated for 7 days. Clinical efficacy as well as arterial blood gas analysis, myocardial enzymes, pulmonary artery pressure, and tricuspid annular plane systolic excursion pre- and post-treatment were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group (94.87% vs. 76.92%, χ2 = 5.18, P < 0.05). After treatment, the partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(36.24 ± 5.12) mmHg vs. (44.25 ± 3.78) mmHg, 1 mmHg = 0.133 kPa, t = 7.86, P < 0.05]. After treatment, the partial pressure of oxygen in the observation group was significantly higher than that in the control group [(78.82 ± 5.1) mmHg vs. (71.23 ± 4.89) mmHg, t = 6.66, P < 0.05]. After treatment, lactate dehydrogenase, creatine kinase, and creatine kinase isoenzyme in the observation group were (107.42 ± 15.45) U/L, (37.21 ± 10.84) U/L, and (12.28 ± 3.54) U/L, respectively, which were significantly lower than (189.94 ± 21.20) U/L, (65.42 ± 6.57) U/L, and (19.29 ± 3.08) U/L in the control group ( t = 19.64, 13.89, 9.33, all P < 0.001). After treatment, the pulmonary arterial pressure in the observation group was significantly lower than that in the control group [(32.24 ± 3.86) mmHg vs. (37.79 ± 5.17) mmHg, t = 5.37, P < 0.001]. Tricuspid annular plane systolic excursion in the observation group was significantly higher than that in the control group [(14.07 ± 1.27) mm vs. (12.63 ± 1.16) mm, t = 5.22, P < 0.001]. Conclusion:Ateplase combined with heparin has an obvious effect on acute moderate- and high-risk pulmonary thromboembolism. It can improve arterial blood gas analysis and reduce myocardial enzyme levels.

A 64-year-old male patient with comminuted intertrochanteric fracture of right femur received subcutaneous injection of 4 100 U nadroparin calcium once daily for anticoagulant treatment due to pulmonary embolism and thrombosis of both lower limbs before operation. His platelet count (PLT) was 166×10 9/L before the treatment. After 5 days of treatment, the dose of nadroparin calcium was increased to 4 100 U once per 12 h. On the 8th day after the dose increase, the patient′s PLT increased to 800×10 9/L. Thrombocytosis was diagnosed, which was considered to be related to nadroparin calcium. The drug was stopped and replaced by rivaroxaban 20 mg once daily orally. Five days later, the patient′s PLT decreased to 590×10 9/L; 34 days later, PLT was 297×10 9/L.

A 64-year-old male patient with comminuted intertrochanteric fracture of right femur received subcutaneous injection of 4 100 U nadroparin calcium once daily for anticoagulant treatment due to pulmonary embolism and thrombosis of both lower limbs before operation. His platelet count (PLT) was 166×10 9/L before the treatment. After 5 days of treatment, the dose of nadroparin calcium was increased to 4 100 U once per 12 h. On the 8th day after the dose increase, the patient′s PLT increased to 800×10 9/L. Thrombocytosis was diagnosed, which was considered to be related to nadroparin calcium. The drug was stopped and replaced by rivaroxaban 20 mg once daily orally. Five days later, the patient′s PLT decreased to 590×10 9/L; 34 days later, PLT was 297×10 9/L.