Key result
Systemic thrombolysis for massive or submassive acute pulmonary embolism requires careful risk-benefit analysis weighing mortality reduction against bleeding risks.
The decision to use thrombolytic therapy for acute pulmonary embolism requires careful risk-benefit analysis, with alteplase being the most studied agent and unfractionated heparin the preferred initial anticoagulant.
Requires individualized risk-benefit assessment in acute PE; leaves open precise selection criteria pending higher-level evidence.
Acute pulmonary embolism is a frequent cause of hospitalization and is associated with a wide range of symptom severity. Anticoagulants are the mainstay of treatment for acute pulmonary embolism; however, in patients with massive or submassive pulmonary embolism, advanced therapy with thrombolytics may be considered. The decision to use thrombolytic therapy for acute pulmonary embolism should be based on careful risk-benefit analysis for each patient, including risk of morbidity and mortality associated with the embolism and risk of bleeding associated with the thrombolytic. Alteplase is currently the thrombolytic agent most studied and with the most clinical experience for this indication, although the most appropriate dose remains controversial, especially in patients with low body weight. When considering thrombolysis, unfractionated heparin is the preferred initial anticoagulant due to its short duration of action and its reversibility should bleeding occur.
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Billie Bartel (2015) conducted a review in Acute pulmonary embolism. Systemic thrombolysis was evaluated. Systemic thrombolysis for massive or submassive acute pulmonary embolism requires careful risk-benefit analysis weighing mortality reduction against bleeding risks.