Abstract
Massive pulmonary embolism (PE) is defined as sustained hypotension, not due to the cause other than PE, pulselessness, or persistent profound bradycardia. Therefore, although PE exhibits variable clinical course, massive PE is a life-threatening condition of which in-hospital mortality reaches over 15% and which consequently requires thrombolysis as well as anticoagulation. According to recent guidelines of PE, systemic thrombolysis is recommended over no such therapy in patients with massive PE who do not have a high bleeding risk. Currently, continuous infusion of alteplase over 2 hours plus anticoagulation using unfractionated heparin constitutes a standard regimen. When systemic thrombolysis is failed or contraindicated, patients with massive PE can undergo surgical embolectomy or catheter-directed thrombolysis, if specialist services and expertise are available. In addition, hemodynamic and respiratory supports, including extracorporeal membrane oxygenation, are needed for successful treatment of massive PE. Keywords: Heparin, Hypotension, Pulmonary embolism, Tissue plasminogen activator
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