Intermediate-Risk Pulmonary Embolism. Thrombolysis, Yes or No?

Abstract

Pulmonary embolism with choc carries a 25–50% mortality rate. Although no large randomized clinical trial is available, some insights of a meta-analysis suggest that thrombolysis decreases the mortality rate in these patients. In patients without clinical evidence of hemodynamic impairment, the mortality rate is much lower and does not justify more aggressive therapy, other than anticoagulants. Recent data, however, suggest that among clinically stable patients, patients with right ventricular dysfunction on echocardiography and abnormal values of cardiac biomarkers have a higher risk of mortality. Thrombolytic therapy reduces the rate of hemodynamic failure and death due to pulmonary embolism, but increases the major bleeding rate and does not reduce overall mortality in patients with these so-called intermediate-risk pulmonary embolisms. In these patients, the use of systemic thrombolysis should be postponed until the occurrence of hemodynamic failure, or restricted to a small group of young patients with a low bleeding risk.