Summary of Contemporary Concepts in Thrombolytic Therapy for Pulmonary Embolism
| Issue | Comment |
|---|---|
| Indications | |
| Normotensive patient with no evidence of RV dysfunction | Thrombolytic therapy not indicated |
| Hypotensive, hypoperfused patient | Thrombolytic therapy indicated |
| Normotensive patient with evidence of RV dysfunction | Consider thrombolytic therapy |
| Diagnosis of pulmonary embolism | May be based on V/Q, spiral CT or transthoracic echocardiography |
| Thrombolytic agents | tPA, SK and UK all equally effective |
| Route of administration | Peripheral vein |
| Time window for therapy | Up to 14 d after symptom onset |
| Complications | Risk of major hemorrhage increased threefold v. heparin Risk of intracranial hemorrhage 1.2% |
RV = right ventricular, V/Q = ventilation-perfusion, tPa = tissue-type plasminogen activator, SK = streptokinase, UK = urokinase.