thrombolysis for pulmonary embolism

Indications

• massive or submassive pulmonary emboli
• hemodynamically unstable

Contraindications

• high risk of bleeding
• age is not a contraindication
• comordidites are not a contraindication

Clinical significance

• thrombolysis decreases mortality relative to anticoagulation (3.9% vs. 2.2%)
  • but increases major bleeding (9.2% vs. 3.4%), including intracranial hemorrhage (1.46% vs. 0.19%)
  • the increased bleeding risk significant only for patients > 65 years of age

Procedure

• thrombolytic agents
  • streptokinase
  • urokinase
  • recombinant tissue plasminogen activator (Alteplase)
    • 50 mg total dose (max)
    • 10 ug bolus followed by 40 mg infusion over 2 hours -= 0.5 mg/kg total dose for patients weighing <50 kg
• heparin therapy is necessary after thrombolytic therapy

* use full dose thrombolytic agent

* 1/2 dose alteplase associated with additional thrombolytic therapy or mechanical thrombectomy

Notes

• unstable patients with pulmonary embolism are less likely to receive thrombolytic therapy if they are elderly or have comorbid conditions
• those who receive thrombolytic therapy have a lower in-hospital case fatality rate regardless of age or comorbid conditions

More general terms

• thrombolytic therapy

Additional terms

• pulmonary embolism (PE)