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Thrombolytic Therapy for Pulmonary Embolism
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There are 2 potential oversights in the comprehensive article by Dalen et al1 that I wish to bring to the authors' attention. Dalen et al argue that for thrombolytic therapy to reduce mortality,
it would have to result in a very rapid resolution of pulmonary embolic obstruction in patients with shock due to massive PE [pulmonary embolism], or it would have to prevent or reduce the incidence of recurrent PE.
The use of thrombolytics can improve survival more than heparin by decreasing the likelihood that an early recurrent pulmonary embolism will be fatal. By rapidly resolving pulmonary embolic obstruction, thrombolytic therapy reduces the probability that an early recurrent embolus will result in hemodynamic compromise or death. Reducing embolic obstruction creates "room to park" an early recurrent embolism. This effect is most important when right ventricular function is already compromised and there is an increased risk of recurrent emboli.
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