RT Journal Article
SR Electronic
T1 Should thrombolysis have a greater role in the management of pulmonary embolism?
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 431
OP 435
DO 10.7861/clinmedicine.9-5-431
VO 9
IS 5
A1 Peter O Jenkins
A1 Javed Sultanzadeh
A1 Manasi Bhagwat
A1 Paul F Jenkins
YR 2009
UL http://www.rcpjournals.org/content/9/5/431.abstract
AB Pulmonary embolism (PE) continues to be associated with significant mortality despite advances in the diagnostic techniques available for its detection. Anticoagulation remains standard treatment in PE although there is a consensus view that ‘step-up’ to thrombolytic therapy in addition to anticoagulation is indicated in those patients who are systemically shocked at presentation – a group defined as having suffered ‘massive pulmonary embolism’. Considerable research has been directed at attempting to identify further groups of patients with PE who are at high risk of morbidity and mortality – notably those who are labelled as having suffered ‘sub-massive pulmonary embolism’ where this is defined as the presence of right-heart strain in the absence of systemic shock. In particular, the potential benefit of extending thrombolytic therapy to include those patients with sub-massive PE has been the subject of much enquiry and debate. This review examines the evidence for thrombolytic therapy and explores the potential for risk stratification in PE.