Systemic Thrombolytic Therapy for Massive and Submassive Pulmonary Embolism

Area of Science:

• Cardiology
• Pulmonary Medicine
• Pharmacology

Background:

• Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
• Thrombolytic therapy is a potential treatment option for PE, but its safety and efficacy require careful evaluation.

Purpose of the Study:

• To critically evaluate the published literature on the safety and efficacy of thrombolytic therapy for massive and submassive pulmonary embolism (PE).

Main Methods:

• A comprehensive literature search was conducted using MEDLINE for human trials up to September 2017.
• Keywords included PE, tissue plasminogen activator, tenecteplase, and alteplase.
• 24 clinical trials investigating intravenous tenecteplase or alteplase for PE outcomes were included.

Main Results:

• Thrombolytic therapy combined with anticoagulation significantly decreased mortality in massive PE compared to anticoagulation alone.
• In submassive PE, thrombolytics reduced right ventricular dysfunction and hemodynamic collapse but increased bleeding risk without improving long-term functional outcomes.

Conclusions:

• Massive PE patients without contraindications should receive thrombolytics.
• Submassive PE patients at high risk for hemodynamic instability require anticoagulation and close monitoring.
• Thrombolytics are indicated for submassive PE if hemodynamic instability or cardiac arrest is imminent and no contraindications exist.
• Balancing the net mortality benefit against bleeding risk is essential when administering thrombolytic therapy for PE.