[Thrombolysis not always necessary in patients with acute pulmonary embolism]

International guidelines suggest that patients presenting with acute pulmonary embolism should be given routine thrombolysis on top of heparin. There is debate as to whether patients with acute pulmonary embolism who present in a haemodynamically stable condition, yet have signs of right ventricular dysfunction and increased troponin, actually need thrombolytic therapy. The results of the Pulmonary Embolism Thrombolysis study (PEITHO) show that in this particular patient group routine thrombolysis led to less haemodynamic decompensation or collapse, but that this advantage came with significantly higher incidences of haemorrhagic stroke and major extracranial bleeding. These results argue against routine thrombolysis in these patients. It is recommended that anticoagulation with heparin and vitamin K antagonists be given and patients be carefully monitored in hospital, particularly during the first three days.