What is the role of thrombolytic therapy in the treatment of venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Thrombolytic therapy dissolves recent clots promptly by activating a plasma proenzyme, plasminogen, to its active form, plasmin. Plasmin degrades fibrin to soluble peptides. Thrombolytic therapy speeds pulmonary tissue reperfusion and rapidly reverses right heart failure. It also improves pulmonary capillary blood flow and more rapidly improves hemodynamic parameters.

The recombinant t-PAs (rt-PAs) tenecteplase, alteplase, and reteplase are thrombolytic agents that the Food and Drug Administration (FDA) has approved for thrombolytic use in PE. In head-to-head studies by Goldhaber et al between rt-PA and heparin, there was a higher incidence of recurrent PE and death in the group receiving heparin. Patients in both groups had bleeding complications requiring transfusion therapy. [52]

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