[Thrombolytic therapy in acute pulmonary embolism]

Area of Science:

• Cardiology
• Pulmonary Medicine
• Thrombosis Research

Context:

• The use of thrombolysis as an adjunctive therapy to heparin for acute pulmonary embolism (PE) has been debated for decades.
• Thrombolysis offers faster resolution of thromboemboli and pulmonary artery pressure normalization compared to heparin alone.
• Its role in hemodynamically stable patients with right heart strain remains controversial due to inconsistent definitions of strain.

Purpose:

• To evaluate the efficacy of thrombolysis in acute pulmonary embolism (PE).
• To introduce and validate the R-S(Wacker) score for quantitative assessment of right heart strain in PE patients.
• To determine prognostic value of the R-S(Wacker) score for in-hospital and 6-month mortality.

Summary:

• The R-S(Wacker) score quantifies right heart strain in PE, demonstrating prognostic value for mortality.
• Patients with normal to moderate R-S(Wacker) scores have excellent outcomes without thrombolysis.
• Thrombolysis may be considered for patients with significant right heart strain, elevated cardiac biomarkers (troponin I/T, BNP), or intracardiac thromboemboli, particularly with a patent foramen ovale.

Impact:

• The R-S(Wacker) score aids in personalized treatment decisions for acute pulmonary embolism.
• It clarifies the role of thrombolysis, reserving it for high-risk patients and potentially avoiding unnecessary interventions.
• This quantitative approach may improve patient outcomes and resource allocation in PE management.