Improved identification of thrombolysis candidates amongst intermediate-risk pulmonary embolism patients: implications for future trials

Contemporary classification of acute pulmonary embolism (PE) severity is based on the risk of early death, which is influenced by demographic factors, comorbidity, and the functional status of the right ventricle (RV) under acute pressure overload [1]. Shock or persistent arterial hypotension, indicating overt RV failure at presentation, has long been identified as a key determinant of poor prognosis [2] and represents the only widely accepted indication for (systemic) thrombolytic therapy to date [3]. In contrast, for normotensive patients who present with imaging findings that indicate RV dysfunction and biochemical evidence of myocardial injury, anticoagulation remains the primary treatment option [3, 4]. This recommendation is supported by the Pulmonary Embolism Thrombolysis (PEITHO) trial, which showed that patients fulfilling these latter criteria were unlikely to derive a net clinical benefit from routine use of systemic thrombolysis in view of the high risk for major bleeding [5].

Source: European Respiratory Journal - January 18, 2018 Category: Respiratory Medicine Authors: Barco, S., Vicaut, E., Klok, F. A., Lankeit, M., Meyer, G., Konstantinides, S. V., on behalf of the PEITHO Investigators Tags: Pulmonary vascular disease Original Articles: Research letters Source Type: research