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Objectives:

Recent evidence suggests that half-dose thrombolysis for pulmonary embolism may provide similar efficacy with reduced bleeding risk compared with full-dose therapy, but comparative studies are lacking. We aimed to evaluate the effectiveness and safety of half-dose versus full-dose alteplase for treatment of pulmonary embolism.

Design:

A retrospective cohort study comparing outcomes in patients receiving half-dose (50 mg) versus full-dose (100 mg) alteplase for pulmonary embolism. We used propensity score matching and sensitivity analyses to address confounding and hospital-level clustering.

Setting:

Data from 420 hospitals obtained from the Premier Healthcare Database between January 2010 and December 2014.

Subjects:

Adult critically ill patients with acute pulmonary embolism treated with IV alteplase therapy.

Interventions:

None.

Measurements and Main Results:

This study included 3,768 …