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Controversies in Internal Medicine
October 24, 2005

Thrombolytic Therapy for Patients With Pulmonary Embolism Who Are Hemodynamically Stable But Have Right Ventricular DysfunctionPro

Author Affiliations

Author Affiliations: Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

 

ANN B.NATTINGERMD, MPH

Arch Intern Med. 2005;165(19):2197-2199. doi:10.1001/archinte.165.19.2197

There is no clinical controversy about patients with massive pulmonary embolism (PE) and hemodynamic collapse. These patients warrant thrombolytic therapy unless contraindications preclude this management strategy. It is also clear that patients with PE who present with normal blood pressure and heart rate as well as normal right ventricular (RV) function will have excellent outcomes with anticoagulation therapy alone. The debate centers on patients with submassive PE who have RV dilatation and hypokinesis despite normal blood pressure. I will make the case for thrombolysis based on the available evidence to support this position. However, I advocate and am helping to organize an international trial of these patients, who fall between the 2 extremes, to provide a definitive answer to this ongoing issue.

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