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	Since this article does not have an abstract, we have provided the first 134 words of the full text and any section headings.

Dr Dalen, in his editorial regarding the role of thrombolytic therapy in the treatment of pulmonary embolism (PE),¹ states that thrombolysis should be considered only in patients with massive PE complicated with shock until the results of a randomized trial become available.

However, such a trial has been published,² which recruited patients with submassive PE (defined as those with confirmed acute PE or right ventricular disfunction but preserved systemic arterial pressure) and showed that heparin plus 100 mg of alteplase, given over a period of 2 hours, prevented clinical deterioration more often than a combination of heparin and placebo, without an increasing of hemorrhagic complications. Thus, thrombolytic therapy should be considered also in selected normotensive patients with PE and right ventricular dysfunction.³

Luca Mascitelli, MD
Udine, Italy

Francesca Pezzetta, MD
Gemona del Friuli, Italy

1. Dalen JE. The uncertain role of thrombolytic therapy in the treatment of pulmonary embolism [editorial]. Arch Intern Med. 2002;162:2521-2523. FREE FULL TEXT 2. Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002;347:1143-1150. FREE FULL TEXT 3. Goldhaber SZ. Thrombolysis for pulmonary embolism. N Engl J Med. 2002;347:1131-1132. FREE FULL TEXT

Arch Intern Med. 2003;163:1238.

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