Tag Archive for: Submassive PE

Episode 38 – Do All Submassive PE’s Require Treatment with Thrombolysis?

15 May
May 15, 2017

Background: There has been very little robust evidence published on the long-term outcomes of systemic thrombolysis in acute submassive PE.  Many advocate for the use of systemic thrombolysis to reduce morbidity (complications from chronic pulmonary hypertension) and mortality. The PEITHO trial compared systemic thrombolysis (with tenecteplase + heparin) vs no systemic thrombolysis (placebo + heparin) in just over 1000 patients with confirmed PE, RV dysfunction, and positive troponins.  The primary outcome of all-cause death or hemodynamic decompensation within 7 days occurred less frequently in the thrombolysis arm. This statistically significant difference was driven by differences in hemodynamic decompensation, not mortality – a non-patient centered outcome. Additionally, the benefit was at the risk of increased intracranial hemorrhage.  In this current study, 70% of the patients from the original PEITHO trial were followed for a 2-year follow up period, giving us some information about long-term sequelae of systemic thrombolysis in patients with submassive PE. Read more →

Treatment of Submassive Pulmonary Embolism (PE): Full Dose, Half Dose, or No Dose?

03 Nov
November 3, 2016

submassive-peSubmassive pulmonary embolism (PE) is responsible for approximately 20% of all PEs.  Although the in-hospital mortality has been reported as about 5%, there is significant morbidity associated with this diagnosis such as chronic pulmonary hypertension, impaired quality of life, persistent right ventricular disfunction, and recurrent venous thromboembolism.  The literature suggests that systemic thrombolytics can improve morbidity and maybe mortality, but this comes at the risk of increased major bleeding and intracranial hemorrhage (2 – 3%) when compared to anticoagulation alone. Read more →

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