Key result
Systemic intravenous thrombolysis decreases mortality in high-risk pulmonary embolism but increases haemorrhagic risk, highlighting the need for tailored drug administration and patient selection.
Why the study?
What are the pathophysiological mechanisms and management challenges regarding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism?
What are the pathophysiological mechanisms and management challenges regarding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism?
This review highlights the pathophysiological mechanisms increasing bleeding risk after thrombolysis in PE and emphasizes the need for tailored drug administration and new monitoring techniques.
Supports individualized thrombolysis decisions in high-risk PE; leaves open optimal regimens and monitoring pending prospective validation.
While systemic intravenous thrombolysis decreases mortality in patients with high-risk pulmonary embolism (PE), it clearly increases haemorrhagic risk. There are many contraindications to thrombolysis, and efforts should aim at selecting those patients who will benefit most, without suffering complications. The current review summarises the evidence for the use of thrombolytic therapy in PE. It clarifies the pathophysiological mechanisms in PE and acute cor pulmonale that increase the risk of bleeding following thrombolysis. It discusses future management challenges, namely tailored drug administration, new treatment monitoring techniques and catheter-directed thrombolysis.
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Abraham et al. (2018) conducted a review in Intermediate-risk and high-risk pulmonary embolism. Thrombolytic therapy was evaluated. Systemic intravenous thrombolysis decreases mortality in high-risk pulmonary embolism but increases haemorrhagic risk, highlighting the need for tailored drug administration and patient selection.
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