Thrombolytic therapy in pulmonary embolism. Which patient should be treated, which regimen should be used?

Summary

The indications of thrombolytic therapy in the management of pulmonary embolism remain unclear. Thrombolysis is a lifesaving procedure in patients with major embolism and cardiogenic shock, but in patients with normal blood pressure, randomized studies did not show a decrease in mortality in patients receiving thrombolysis. Recent data however suggest that this therapy may be beneficial in patients with major pulmonary embolism and evidence of right ventricular afterload.

Several controlled studies have compared different thrombolytic regimen in patients with pulmonary embolism and indicate that a 2-h infusion of rtPA or urokinase is more rapidly effective than a 12 to 24-h infusion of either streptokinase or urokinase and that a 0.6 mg/kg bolus injection of rtPA is as effective and safe as the 2-h 100 mg regimen.