Q J Med 2004; 97: 361-364
QJM vol. 97 no. 6 © Association of Physicians 2004; all rights reserved.
Commentary |
Thrombolysis in pulmonary embolism: are we under-using it?
From the Cardiothoracic Department, Central Middlesex Hospital, London, UK
| The first 150 words of the full text of this article appear below. |
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Introduction |
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Pulmonary embolism is a common condition leading to significant morbidity and mortality. Standard initial therapy consists of heparin treatment, which has been shown to improve the outcome. Nevertheless, 3-month mortality remains high, ranging from 10% to 17.5%, and is higher for massive PE.1–3 Thrombolysis for acute PE remains a controversial treatment, due in part to the inadequate evidence demonstrating an improvement in outcome. Current British Thoracic Society (BTS) guidelines for thrombolysis suggest its use only in massive PE, which it defines as ‘one so severe as to cause circulatory collapse’.4 Over the last year, we have experienced four cases of pulmonary embolism that were successfully thrombolysed due to respiratory failure despite being haemodynamically stable. This led us to review some of the evidence for thrombolysis in PE, and this commentary investigates the potential for expanding the role of thrombolysis in this condition, suggesting its use in respiratory failure as well
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Current evidence for thrombolysing only haemodynamically compromising PEs |
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Should the role of thrombolysis in PE be extended? |
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Lack of evidence
Which PEs may be candidates for thrombolysis?
Thrombolysis for respiratory failure and not just circulatory failure?
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Conclusions |
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Address correspondence to be sent to Dr M.R. Loebinger, Specialist Registrar in Respiratory Medicine, Cardiothoracic Dept., Central Middlesex Hospital, Acton Lane, London NW10 7NS. e-mail: mloebinger@doctors.org.uk