Dr Dalen, in his editorial regarding the role of thrombolytic therapy in the treatment of pulmonary embolism (PE),1 states that thrombolysis should be considered only in patients with massive PE complicated with shock until the results of a randomized trial become available.
However, such a trial has been published,2 which recruited patients with submassive PE (defined as those with confirmed acute PE or right ventricular disfunction but preserved systemic arterial pressure) and showed that heparin plus 100 mg of alteplase, given over a period of 2 hours, prevented clinical deterioration more often than a combination of heparin and placebo, without an increasing of hemorrhagic complications. Thus, thrombolytic therapy should be considered also in selected normotensive patients with PE and right ventricular dysfunction.3
Mascitelli L, Pezzetta F. Thrombolysis in the Treatment of Submassive Pulmonary Embolism. Arch Intern Med. 2003;163(10):1238. doi:10.1001/archinte.163.10.1238-a