Thrombolytic therapy with urokinase for pulmonary embolism in patients with stable hemodynamics

Thrombolytic agents such as urokinase have been used in the treatment of patients with massive pulmonary embolism and hypotension, but their effect in patients with submassive pulmonary embolism and normal blood pressure has been controversial.

Urokinase (20,000 IU /kg) was intravenously administered to 36 patients who had pulmonary embolism and a normal blood pressure. This was followed by subcutaneous injection of a low-molecular-weight heparin for a week.

Improvement in clinical symptoms and reduction in pulmonary pressure was observed in 28 (77.8%) patients within the first week of the thrombolytic therapy. The improvement rate in patients with embolic symptoms of less than 14 days, and in those who had symptoms between 14 and 30 days before the thrombolytic therapy was 86% and 50%, respectively (p<0.01). Non-life threatening bleeding complications were observed in 10 (22.2%) patients.

Thrombolytic therapy with urokinase followed by low-molecular-weight heparin is an effective therapeutic strategy for patients with pulmonary embolism and stable haemodynamics. However, the long-term benefits of this strategy remain to be seen and further studies are warranted.