Thrombolytic Therapy for Pulmonary Embolism

MORE than 30 years after the first clinical reports of thrombolytic therapy for the treatment of acute pulmonary embolism (PE)¹,²its indications still remain uncertain. The most widely accepted indication for thrombolytic therapy for PE is in patients with hypotension secondary to massive PE.³However, the number of patients with PE who present with shock and who do not have 1 or more contraindications to thrombolytic treatment is very small. The first 2 thrombolytic agents that were approved by the Food and Drug Administration (FDA) for the treatment of acute PE were streptokinase (1977) and urokinase (1978). These 2 agents were compared with heparin in 2 randomized clinical trials.⁴,⁵ The successful results of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of acute myocardial infarction led to its evaluation for the treatment of acute PE. The first report of rt-PA in the treatment of PE by Bounameaux