Thrombolytics for Pulmonary Embolism
Heparin is the standard treatment for large pulmonary embolism but in certain rare instances, thrombolytics are sometimes used. However, most studies suggest that thrombolytic therapy does not affect the risk of death (Cochrane Database Syst Rev, 2006), but it may improve right ventricular function in the first 3 days of treatment. However, this benefit needs to be weighed against a 3% risk of a clinically significant hemorrhage. Although such a risk is mainly seen in older patients, there have been a number of reports of serious hemorrhage in children. One of the discussants in this case, explains the fact that he only uses thrombolytics when the patient with a large pulmonary embolism is in shock.
Teaching topics from the New England Journal of Medicine - Vol. 358, No. 9, February 28, 2008