Thrombolysis in pulmonary embolism (PE)

NICE suggest (1):

• pharmacological systemic thrombolytic therapy should be considered for people with PE and haemodynamic instability
• do not offer pharmacological systemic thrombolytic therapy to people with PE and haemodynamic stability with or without right ventricular dysfunction

Systemic thrombolytic therapy is recommended for high-risk PE (2):

• a meta-analysis of thrombolysis trials that included (but were not confined to) patients with high-risk PE, defined mainly as the presence of cardiogenic shock, indicated a significant reduction in the combined outcome of mortality and recurrent PE. This was achieved with a 9.9% rate of severe bleeding and a 1.7% rate of intracranial aemorrhage

Reference:

• NICE (March 2020). Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing
• .Konstantinides SV et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019 Oct 9;54(3)