In reply
The report by Konstantinides et al1 of a randomized trial of alteplase plus heparin vs heparin alone in patients with acute PE complicated by right ventricular dysfunction, but without systemic hypotension or shock, was long awaited.
My conclusion from this important study is different than that of Mascitelli and Pezzetta. I believe that this study indicated that the safest and most cost-effective therapy for PE complicated by right ventricular dysfunction without shock is heparin with the option of secondary thrombolysis.
The bottom line of this well-performed study was that the mortality and incidence of documented recurrent PE were the same in the 118 patients randomized to receive alteplase plus heparin as in the 138 patients who were randomized to receive heparin alone, with the option of secondary thrombolysis with alteplase if clinical conditions worsened. Thirty-two of the 138 patients randomized to heparin alone received secondary thrombolysis; the other . . . [Full Text of this Article]
