[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.166.74.94. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Citations 0
Controversies in Internal Medicine
October 24, 2005

Rebuttal

Author Affiliations
 

ANN B.NATTINGERMD, MPH

Arch Intern Med. 2005;165(19):2204-2205. doi:10.1001/archinte.165.19.2204-a

The proponents of thrombolysis for patients with PE and RV dysfunction stress the high mortality rates of such patients without treatment and the well-proven hemodynamic benefit of thrombolysis in this setting. Conversely, the opponents emphasize the doubtful prognostic significance of RV dysfunction and the lack of evidence of clinical benefit and potentially life-threatening adverse effects of thrombolysis.

To move forward the debate, Goldhaber has long championed the implementation of a large international trial comparing thrombolysis and heparin in patients with acute PE and RV dysfunction.1,2 At the same time, the proponents of this treatment stress the difficulties in launching such a large-scale trial; the largest randomized controlled trial with published results to date included only 256 patients. Funding support and recruitment difficulties are the 2 arguments commonly used against launching a large-scale trial.3

First Page Preview View Large
First page PDF preview
First page PDF preview
×