The report by Konstantinides et al1 of a randomized trial of alteplase plus heparin vs heparin alone in patients with acute PE complicated by right ventricular dysfunction, but without systemic hypotension or shock, was long awaited.
My conclusion from this important study is different than that of Mascitelli and Pezzetta. I believe that this study indicated that the safest and most cost-effective therapy for PE complicated by right ventricular dysfunction without shock is heparin with the option of secondary thrombolysis.
Dalen JE. Thrombolysis in the Treatment of Submassive Pulmonary Embolism—Reply. Arch Intern Med. 2003;163(10):1238. doi:10.1001/archinte.163.10.1238-a