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Thrombolysis for pulmonary embolism.

R S Porter1, J R Dipalma

  • 1Hahnemann University School of Medicine, Philadelphia, Pennsylvania.

American Family Physician
|October 1, 1991
PubMed
Summary

Thrombolytic therapy offers clear benefits for pulmonary embolism, including faster clot lysis and improved blood flow. While not universally adopted, it shows definite advantages in hemodynamically compromised patients.

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Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Thrombosis Management

Background:

  • Thrombolytic therapy for pulmonary embolism (PE) has shown advantages over heparin therapy for over a decade.
  • Recombinant tissue plasminogen activators like alteplase further confirmed these benefits.
  • Despite FDA approval, thrombolytic therapy for PE lacks universal acceptance.

Purpose of the Study:

  • To review the established and claimed benefits of thrombolytic therapy for pulmonary embolism.
  • To assess the current acceptance and potential patient population for thrombolytic therapy in PE.
  • To highlight the specific advantages in hemodynamically compromised PE patients.

Main Methods:

  • Literature review of studies comparing thrombolytic therapy with heparin for pulmonary embolism.
  • Analysis of evidence supporting claimed benefits such as reduced mortality and chronic pulmonary hypertension.
  • Discussion of patient selection criteria and current clinical practice trends.

Main Results:

  • Clear advantages include improved pulmonary capillary blood volume, accelerated clot lysis, and enhanced pulmonary perfusion.
  • Claimed benefits like earlier reversal of right-sided heart failure, reduced recurrent PE, and lower mortality require further definitive proof.
  • Approximately 50% of PE patients may be candidates for thrombolytic therapy.
  • Thrombolysis demonstrates definite advantages over heparin in patients with hemodynamic compromise.

Conclusions:

  • Thrombolytic therapy offers significant advantages in specific aspects of pulmonary embolism management.
  • Further research is needed to substantiate all claimed benefits, particularly regarding mortality and long-term outcomes.
  • Thrombolysis is a crucial treatment option for hemodynamically unstable patients with pulmonary embolism.

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