Thrombolysis in Pulmonary Embolism

The standard therapy for acute pulmonary embolism is initiated with heparin. Massive pulmonary embolism (PE) is defined by\nthe presence of cardiogenic shock, persistent arterial hypotension, or both. It is associated with a high risk of in-hospital death, particularly\nduring the first hours after admission. Thrombolysis is recommended in massive PE. Results from a randomized trial suggested\nthat selected patients with evidence of right ventricular dysfunction and a low risk of bleeding may benefit from\nthrombolysis. In this issue of the Journal, Kim Yang-Ki and colleagues conducted retrospective review of thrombolytic therapy in\nPE last 6.5 years in a single center. The mortality rate of massive PE (44%) was higher than submassive PE (8%) in patients with\nthrombolysis. Major bleeding occurred in 3/21 (14%) patients. This signal reminds us “real-world” hazards of thrombolysis is higher\nthan randomized controlled trial. Although massive PE patients need more intensifying therapy to reduce mortality, we should\ncareful assessment of bleeding risk factors before starting thrombolysis. With regard to submassive PE, this study has limitation to\nassessing the efficacy of thrombolysis. (Korean J Med 2013;84:46-48)\nKeywords: Pulmonary embolism; Thrombolysis; Bleeding