Thrombolysis in Pulmonary Embolism: An Evidence-Based Approach to Treating Life-Threatening Pulmonary Emboli

Crit Care Clin. 2020 Jul;36(3):465-480. doi: 10.1016/j.ccc.2020.02.004.

Abstract

Acute pulmonary embolism (PE) is associated with high in-hospital morbidity and mortality, both via cardiorespiratory decompensation and the bleeding complications of treatment. Thrombolytic therapy can be life-saving in those with high-risk PE, but requires careful patient selection. Patients with PE and systemic arterial hypotension ("massive PE") should receive thrombolytic therapy unless severe contraindications are present. Patients with PE and right ventricular dysfunction/injury, but without hypotension ("submassive PE"), should be considered for thrombolysis on a case-by-case basis, considering bleeding risk, cardiac biomarkers, echocardiography, and most importantly, clinical status.

Keywords: Anticoagulation; Massive; Pulmonary embolism; Submassive; Thrombolysis; Venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Acute Disease / therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / therapy*
  • Risk Factors
  • Thrombolytic Therapy / standards*
  • Treatment Outcome
  • Ventricular Dysfunction, Right / diagnosis*
  • Ventricular Dysfunction, Right / therapy*

Substances

  • Fibrinolytic Agents