Abstract
Objectives: To evaluate short-term and mid-term outcomes of systemic Alteplase thrombolysis in patients with acute pulmonary embolism (APE) treated at the Vietnam National Heart Institute – Bach Mai Hospital. Methods: A retrospective descriptive study with longitudinal follow-up of 52 patients with MSCT-confirmed pulmonary embolism treated with Alteplase at the Vietnam National Heart Institute, Bach Mai Hospital (January 2019–April 2025). Short-term outcomes were assessed during hospitalization; mid-term outcomes were evaluated in surviving patients after discharge. Results: Mean age was 61.7 ± 16.6 years, with female predominance; most patients were high-risk by PESI. Thrombolysis significantly improved hemodynamics and right ventricular function, with reduced RV dilation and McConnell’s sign and increased TAPSE (p<0.001). Bleeding complications were acceptable. During mid-term follow-up (n=22), higher pulmonary artery pressure and lactate at discharge were associated with mortality. Survivors (n=17) showed improved respiratory status with mostly mild residual symptoms. Conclusions: Alteplase provides rapid hemodynamic and right ventricular improvement with acceptable safety. Benefits tend to persist in the mid-term, underscoring the need for close follow-up in high-risk patients.
