Thrombolysis for acute pulmonary embolism in Chinese patients.

Abstract

Sir, Acute pulmonary embolism is potentially fatal unless treated early. Thrombolytic therapy is beneficial for patients with acute pulmonary embolism who are hypotensive and have arterial hypoxaemia1, and those who are clinically stable but with echocardiographic evidence of right heart failure.2 However, in the Pulmonary Embolism Registry, the rate of major bleeding was higher in patients receiving thrombolytic therapy (21%) than in those on anticoagulation treatment (7.8%). In one study examining risk factors associated with bleeding in patients receiving thrombolysis for pulmonary embolism,3 the relative risk of bleeding was 3.9 among patients aged >70 years compared with those aged <50 years. With age as a continuous variable, the risk of bleeding increased by 4% for each additional year.3 The Food and Drug Association (FDA)‐approved regimen of recombinant tissue plasminogen activator (rtPA) for treatment of acute pulmonary embolism is 100 mg as a continuous peripheral intravenous infusion over 2 h.4 In our centre, we try to give a lower dose of rtPA for treatment of acute massive pulmonary embolism in the elderly. We assume …