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Thrombolysis for pulmonary embolism: Past, present and future
Mareike Lankeit1, Stavros Konstantinides
1Department of Cardiology and Pulmonology, Georg August University of Göttingen, Göttingen, Germany.
Thrombosis and Haemostasis
|March 11, 2010
Summary
Thrombolytic treatment significantly reduces in-hospital death for high-risk pulmonary embolism (PE) patients. For intermediate-risk PE, early thrombolysis may benefit selected patients with low bleeding risk, pending further trial results.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Critical Care Medicine
Background:
- High-risk pulmonary embolism (PE) patients with shock or hypotension face significant in-hospital mortality.
- Prompt heparin anticoagulation offers a favorable prognosis for normotensive (non-high-risk) PE patients.
Purpose of the Study:
- To evaluate the efficacy and safety of thrombolytic treatment in high-risk and intermediate-risk pulmonary embolism.
- To guide treatment decisions for PE patients based on hemodynamic status and risk stratification.
Main Methods:
- Meta-analysis of trials involving hemodynamically compromised PE patients.
- Review of uncontrolled data for thrombolysis as an alternative to surgery in specific PE cases.
- Analysis of risk factors including right ventricular dysfunction and myocardial injury in normotensive PE patients.
Main Results:
- Thrombolysis significantly reduces in-hospital death and PE recurrence in high-risk PE patients.
- Thrombolysis may be a safe and effective alternative to surgery for PE with free-floating right heart thrombi.
- Normotensive PE patients generally do not benefit from thrombolysis due to outweighing bleeding risks.
Conclusions:
- Thrombolysis is recommended for high-risk PE patients unless contraindicated.
- Selected intermediate-risk PE patients with evidence of right ventricular dysfunction or myocardial injury may benefit from early thrombolysis, especially with low bleeding risk.
- Optimal treatment for intermediate-risk PE remains under investigation pending large trial outcomes.
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