A single-centre retrospective cohort compared initial low-dose (50 mg) versus standard-dose (100 mg) alteplase in 65 patients with high-risk pulmonary embolism. Sustained haemodynamic stability within 24 hours occurred in 32% versus 38% (P=.65), and in-hospital mortality was 48% versus 45% (P=.81), respectively. Mechanical ventilation duration was shorter in the low-dose group (1.5 versus 6 days; P=.03). Major bleeding occurred in 12% versus 25% (P=.34); this nonsignificant comparison does not establish a bleeding advantage, and the absence of significant differences in stability or mortality does not establish equivalence.
This small observational cohort found no statistically significant difference in haemodynamic stability or mortality between dosing groups. The shorter ventilation duration is hypothesis-generating rather than evidence of a causal benefit.
Study limitation: The small, single-centre retrospective cohort is vulnerable to confounding and provides limited certainty about comparative effectiveness or bleeding risk.
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