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Updated: May 18, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolytic therapy for submassive pulmonary embolism
Mareike Lankeit1, Stavros Konstantinides
1Department of Cardiology and Pulmonology, Georg August University of Göttingen, Germany.
Best Practice & Research. Clinical Haematology
|September 11, 2012
Summary
Pulmonary embolism (PE) risk varies greatly. This study investigates if thrombolytic treatment benefits normotensive PE patients with right ventricular dysfunction and myocardial injury, potentially resolving a long-standing clinical debate.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Acute pulmonary embolism (PE) has a significant mortality rate, with risk varying widely among patients.
- Current treatment guidelines differentiate between massive PE requiring thrombolysis and normotensive PE managed with anticoagulation.
- There is a need for better risk stratification in normotensive PE patients, particularly identifying an intermediate-risk group (submassive PE).
Purpose of the Study:
- To determine if early thrombolytic treatment benefits normotensive patients with submassive PE.
- To evaluate the efficacy of combining imaging (echocardiography/CT) and biomarker (troponin) data for guiding treatment decisions in PE.
- To address the ongoing debate regarding thrombolysis in submassive pulmonary embolism.
Main Methods:
- A large multinational randomized trial involving 1000 patients across 13 European countries.
- Patients included had normotensive PE with evidence of right ventricular dysfunction (via echocardiography or CT) and myocardial injury (positive troponin test).
- Comparison of early thrombolytic treatment versus standard anticoagulation in this specific patient subgroup.
Main Results:
- The trial is currently underway and expected to complete in 2012.
- Data from this and a parallel US trial will provide crucial insights into treatment efficacy.
- Results aim to clarify the role of thrombolysis in submassive PE management.
Conclusions:
- The findings are anticipated to resolve a 40-year-old debate on thrombolysis for submassive PE.
- This research will significantly impact clinical management strategies for acute pulmonary embolism.
- Establishing optimal treatment for intermediate-risk PE patients is the ultimate goal.
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