Thrombolysis in Pulmonary Embolism

Choi, Won Il

Abstract

The standard therapy for acute pulmonary embolism is initiated with heparin. Massive pulmonary embolism (PE) is defined by the presence of cardiogenic shock, persistent arterial hypotension, or both. It is associated with a high risk of in-hospital death, particularly during the first hours after admission. Thrombolysis is recommended in massive PE. Results from a randomized trial suggested that selected patients with evidence of right ventricular dysfunction and a low risk of bleeding may benefit from thrombolysis. In this issue of the Journal, Kim Yang-Ki and colleagues conducted retrospective review of thrombolytic therapy in PE last 6.5 years in a single center. The mortality rate of massive PE (44%) was higher than submassive PE (8%) in patients with thrombolysis. Major bleeding occurred in 3/21 (14%) patients. This signal reminds us "real-world" hazards of thrombolysis is higher than randomized controlled trial. Although massive PE patients need more intensifying therapy to reduce mortality, we should careful assessment of bleeding risk factors before starting thrombolysis. With regard to submassive PE, this study has limitation to assessing the efficacy of thrombolysis.