Abstract
Pulmonary embolism (PE) is a major cause of acute cardiovascular mortality and long-term
morbidity. Right ventricular (RV) dysfunction is the key determinant of prognosis
in the acute phase of PE, and residual RV dysfunction is associated with the development
of post-PE functional impairment, chronic thromboembolic disease, and higher costs
of treatment over the long term. Patients with clinically overt RV failure, i.e. hemodynamic
collapse at presentation (high-risk PE), necessitate immediate thrombolytic treatment
to relieve the obstruction in the pulmonary circulation; surgical or catheter-directed
removal of the thrombus can be an alternative option. For patients with a high risk
of bleeding or active hemorrhage, or for normotensive patients with intermediate-risk
PE, systemic (intravenous) standard-dose thrombolysis is not recommended since the
risks of treatment outweigh its benefits. In such cases, rescue thrombolysis should
be considered only if hemodynamic decompensation develops while on heparin anticoagulation.
For survivors of acute PE, little is known on the possible effects of thrombolytic
treatment on the risk of chronic functional and hemodynamic impairment. Catheter-directed,
ultrasound-assisted, low-dose thrombolysis leads to recovery of RV dysfunction, and
its safety profile appears promising. However, adequately powered prospective trials
focusing on both short- and long-term clinical outcomes are needed to establish novel
interventional techniques in the treatment of PE.
Keywords
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Article info
Publication history
Published online: June 01, 2017
Accepted:
May 31,
2017
Received in revised form:
May 27,
2017
Received:
May 1,
2017
Identification
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© 2017 Elsevier Ltd. All rights reserved.
