[Choice of the method of thrombolytic therapy in massive pulmonary embolism]

Analysis of the results of using fibrinolysis activators in 196 patients with massive embolism of the pulmonary arteries was undertaken to choose the optimum method of thrombolytic therapy. High doses of fibrinolysis activators (from 5,000,000 to 7,000,000 U) were used in 127 cases and low doses (from 125,000 to 3,000,000 U) in combination with heparin and disaggregating agents in the remaining 69 cases. A cava-filter was implanted in 161 patients before beginning treatment. Obvious advantages of thrombolytic therapy of massive pulmonary embolism with high doses of fibrinolysis activators were revealed in the process of treatment. They consist in quicker restoration of continuity of the pulmonary arteries, which leads to rapid removal of hypertension in pulmonary circulation and reduction of the number of deaths from acute cardiopulmonary failure. Treatment with such doses does not lead to an increase of the number of hemorrhagic complications, which makes possible surgical prevention of recurrent pulmonary embolism by cava-filter implantation.