Thrombolyse bei Akuter Schwerer Lungenembolie

Thrombolysis for acute severe pulmonary embolism. This review considers the present thrombolytic strategies for the treatment of acute severe pulmonary embolism. The administration of recombinant tissue plasminogen activator (100 mg alteplase), of urokinase (3 mio units) or streptokinase (1.5–4 mio units) within two hours is faster than the classical thrombolysis schemes to reduce pulmonary vascular resistance and right ventricular overload. The most important adverse effect of thrombolytic therapy is a threefold increased relative risk of severe haemorrhage compared to heparin alone With a 1% absolute risk of intracranial bleeding. Until now no studies have been large enough to demonstrate a statistically significant mortality reduction by thrombolysis. Whereas most experts accept thrombolytic treatment for severe pulmonary embolism With unstable circulation (hypotension, Shock, syncope), opinions differ about the use of thrombolysis in haemodynamically stable pulmonary embolism cases. In these cases echo-cardiographic evidence of right ventricular dysfunction may help to identify high-risk patients for whom thrombolytic treatment is life saving.