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Updated: Nov 9, 2025

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Thrombolytic therapy for pulmonary embolism.

Zhiliang Zuo1,2, Jirong Yue1,2, Bi Rong Dong1,2

  • 1The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.

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Summary

Thrombolytic therapy for pulmonary embolism (PE) may reduce deaths and clot recurrence, but increases bleeding risks. Further high-quality studies are needed to confirm safety and cost-effectiveness.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Thrombosis Management

Background:

  • Pulmonary embolism (PE) is a serious condition often treated with anticoagulants like heparin.
  • Thrombolytic therapy is typically reserved for severe PE cases due to potential risks.

Purpose of the Study:

  • To assess the efficacy and safety of thrombolytic therapy for acute pulmonary embolism.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Included trials compared thrombolytics plus heparin versus heparin alone or placebo.
  • Searched major databases up to August 2020.

Main Results:

  • Thrombolytics likely reduce death (low-certainty evidence) and PE recurrence (low-certainty evidence) compared to control.
  • Increased risk of major (moderate-certainty) and minor (low-certainty) bleeding events, including hemorrhagic stroke.
  • Shorter hospital stays and reduced hemodynamic decompensation observed with thrombolytics.

Conclusions:

  • Thrombolytic therapy may improve outcomes in acute PE but carries a higher bleeding risk.
  • Evidence quality is limited by risk of bias and heterogeneity.
  • More high-quality research is required to evaluate safety and cost-effectiveness.