title: [Thrombolytic therapy for pulmonary embolism].
abstract: 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.
authors.affiliation: Service de Pneumologie, Université Paris Descartes, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. guy.meyer@egp.aphp.fr
authors.forename: G
authors.initials: G
authors.lastname: Meyer
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D000075202:Contraindications; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D015912:Thrombolytic Therapy; D014336:Troponin / Q000097:blood*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014336:Troponin; D020097:Natriuretic Peptide, Brain