ANN B.NATTINGERMD, MPH
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
Thabut G, Logeart D. Rebuttal. Arch Intern Med. 2005;165(19):2204-2205. doi:10.1001/archinte.165.19.2204-a