When is thrombolytic therapy indicated in pulmonary embolism (PE)?

Updated: Sep 18, 2020
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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All patients with PE require rapid risk stratification. Thrombolytic therapy should be used in patients with acute PE associated with hypotension (systolic BP< 90 mm HG) who do not have a high bleeding risk. [5] Do not delay thrombolysis in this population because irreversible cardiogenic shock can develop. Thrombolytic therapy is suggested in select patients with acute PE not associated with hypotension and with a low bleeding risk whose initial clinical presentation or clinical course after starting anticoagulation suggests a high risk of developing hypotension. Assessment of pulmonary embolism severity, prognosis, and risk of bleeding dictate whether thrombolytic therapy should be started. Thrombolytic therapy is not recommended for most patients with acute PE not associated with hypotension. [5]

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