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June 18, 2014

Thrombolytic Therapy for Pulmonary Embolism

Author Affiliations
  • 1Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2014;311(23):2385-2386. doi:10.1001/jama.2014.5993

Pulmonary embolism (PE) accounts for nearly 200 000 hospital discharges and contributes to nearly 30 000 deaths in the United States each year.1 Treatment of PE requires balancing the benefits of anticoagulation with the risk of bleeding. Determining the value of a therapy, incorporating both therapeutic and adverse effects, requires understanding net clinical benefit, the weighing of net benefit (or harm) for a specific therapy.2 Currently, anticoagulation is standard therapy for patients with PE because the risk of fatal bleeding is low compared with the benefit of reduced mortality and recurrent PE. In contrast, more than 40 years after the first trial of thrombolysis was published, the role of thrombolytic therapy in PE remains unclear, because no single clinical trial has provided a definitive answer about its benefit. Furthermore, because of the increased risk of major bleeding, there is uncertainty about which patients may benefit from thrombolysis.