Thrombolytic therapy for pulmonary embolism

Pulmonary embolism with choc carries a 25 to 50% mortality rate. Although no large randomized clinical trial is available, some insights of a meta-analysis suggest that thrombolysis decreases the mortality rate in these patients. In patients without clinical evidence of haemodynamic impairment, the mortality rate is much lower and does not justify more aggressive therapy other than anticoagulants. Recent data however suggest that among clinically stable patients, some may have a higher mortality risk. These so called sub-massive or intermediate-risk pulmonary embolism are defined either by right ventricular dysfunction assessed by echocardiography or by elevated troponin or brain natriuretic peptide. The role of thrombolytic treatment in these patients remains controversial. A large randomized controlled trial is underway to resume the debate.