Abstract
Thrombolytic treatment accelerates the dissolution of thrombus in acute pulmonary thromboembolism (PTE) and is potentially a lifesaving treatment. High-risk PTE is the clearest indication for this therapy, and its use in intermediate-risk cases is still controversial. A PTE response team may enable a rapid and effective determination of risk and treatment in these controversial clinical cases. Approved thrombolytic agents for the PTE treatment are streptokinase, urokinase, and alteplase. Currently, the most widely used agent is alteplase. It has a short infusion time (2 h) and a rapid effect. Newer, unapproved agents for the PTE treatment are tenecteplase and reteplase. The active resolution of thrombus via thrombolytic agents improves rapidly pulmonary perfusion, hemodynamic defect, gas exchange, and right ventricular dysfunction. However, it is important to determine appropriate candidates carefully, to prevent hemorrhage, which is the most important side effect of these drugs. Catheter-directed thrombolysis seems to be an alternative in patients not eligible for systemic thrombolytic therapy.
Highlights
Pulmonary thromboembolism (PTE) is a common disease that may be life threatening
Thrombolytic treatment accelerates the dissolution of thrombus in acute pulmonary thromboembolism (PTE) and is potentially a lifesaving treatment
Catheter-directed thrombolysis seems to be an alternative in patients not eligible for systemic thrombolytic therapy
Summary
Pulmonary thromboembolism (PTE) is a common disease that may be life threatening. The mortality rate can reach up to 65% in high-risk patients [1]. Thrombolytic Therapy in Pulmonary Thromboembolism 187 signs of hypotension or shock at presentation, they are considered high-risk regardless of these parameters [3]. Intermediate-risk (submassive) PTE: patients without shock or hypotension but with signs of RV dysfunction and/or positive cardiac biomarkers or sPESI >1. For intermediate-/high-risk patients (those with severe hypoxemia, diffuse perfusion defect, severe or worsening RV dysfunction, PTE-related cardiopulmonary arrest, free thrombus in the right atrium or ventricle, and/or foramen ovale opening) without hypotension or shock, thrombolytic therapy is recommended if there is a low risk of bleeding [3, 18]. Numerous studies have shown that thrombolytic agents improve RV dysfunction, and a meta-analysis revealed a survival advantage [20,21,22,23,24] The largest of these studies is the Pulmonary Embolism Thrombolysis Study. Data on the use of thrombolytics in patients with severe hypoxemia, PTE-related cardiopulmonary arrest, and free thrombus in the right ventricle or atrium are limited, and a case-based approach is recommended [27]
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