When should we thrombolyse patients with pulmonary embolism?
The early mortality in patients with pulmonary embolism is largely predicted by the associated cardiovascular response. Progressive right ventricular failure, hypotension, shock, and circulatory arrest are associated with increasing mortality. Thrombolysis may improve the prognosis of pulmonary embolism associated with these varying degrees of circulatory collapse, but has no place in the treatment of small emboli with no cardiovascular compromise, as it carries an important risk of haemorrhage. This review sets out to guide the emergency physician in deciding which patients with pulmonary embolism may benefit from thrombolysis.
