[Pulmonary embolism. Current aspects of treatment]

INDICATIONS FOR DRUG THROMBOLYSIS: There has been much debate on the indications for drug thrombolysis in pulmonary embolism. Thrombolysis would not appear to be justified excepting in massive pulmonary embolism when clinical signs or explorations evidence poor hemodynamic tolerance. Current data would confirm its independent effect on reducing mortality in such cases. MECHANICAL THROMBOLYSIS: The clinical efficacy of mechanical thrombolysis has not been demonstrated. It should not be used outside rigorously controlled clinical trials in patients with severe pulmonary embolism and with a formal contraindication for drug thrombolysis or in case of failure. THE PREPIC STUDY: The first controlled prospective trial on caval filters confirmed that indications for caval interruption in patients with proximal deep vein thrombosis should be limited to contraindications and failures of anticoagulant therapy. Other indications for filters, whether temporary or definitive, should be evaluated with specific controlled prospective trials. LOW-MOLECULAR WEIGHT HEPARINS: If this possibility is confirmed for the treatment of pulmonary embolism, it will provide a simple rational treatment for venous thromboembolism. 'SMALL CLOTS': Changing diagnostic strategies, particularly the use of helical CT angiography, has raised the question of therapeutic abstention when "small" clots are undetectable by this exploration.