PCCU Lesson 19, Volume 14—Thrombolytic Therapy in Massive and Submassive Pulmonary Embolism

Pulmonary embolism (PE) and deep vein thrombosis encompass the syndrome of venous thromboembolism (VTE). In the United States, VTE has a reported incidence of 1 in 1,000 persons yearly and account for approximately 250,000 hospitalizations each year.1 As many as 50 to 60% of patients with deep vein thrombosis develop symptomatic or asymptomatic PE.2 The case-fatality ratio for PE has been reported to be approximately 4 to 12%.1,3 The International Cooperative Pulmonary Embolism Registry has demonstrated a 3-month mortality rate of 17.5% for PE. This alarming observation has led many clinicians to re-evaluate the use of thrombolytic therapy in PE. This lesson will focus on the natural course of heparin-treated massive and submassive PE, the risk stratification of patients with PE, and the current recommendations for thrombolytic therapy for this disease.