Thrombolysis in submassive pulmonary embolism, prudent or puerile?
Pulmonary embolism (PE) remains one of the leading causes of cardiovascular mortality. The safety and efficacy of thrombolytic therapy using tissue-type plasminogen activator (tPA) for acute PE in clinical practice remain unclear. We describe a case of life-threatening submassive PE causing extreme refractory hypoxaemia, where thrombolysis was successfully administered. Current consensus suggests that patients with features of hemodynamic instability as a result of an acute PE, that is, massive PE, should receive thrombolysis. Patients, not in shock however, but with evidence of right-ventricular (RV) dysfunction echocardiographically, that is, submassive PE may also benefit. Serum troponin and brain-type natriuretic peptide have been suggested as biomarkers of RV injury that may identify a subset of submassive PE patients who may particularly benefit from thrombolytic therapy. The clinical response of this patient to thrombolysis is important, as it may identify a subgroup of patients with submassive PE who warrant this intervention.
Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA. a0rehm01@louisville.edu
Aamer
A
Rehman
Shafaq
S
Yousaf
Atul
A
Chugh
D004417:Dyspnea / Q000209:etiology; D017128:Embolectomy; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016312:Treatment Refusal; D014463:Ultrasonography
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator