Thrombolysis for Pulmonary Embolus: How Good Is It?

A recent randomized trial of heparin alone versus alteplase plus heparin for treatment of submassive pulmonary embolism with right ventricular dysfunction demonstrated no difference in mortality, but the alteplase plus heparin group required fewer upgrades in level of care. The authors concluded that the reduced need for upgrades justifies the use of thrombolysis. Using data from that trial and other studies, researchers performed a cost-effectiveness analysis to assess the health and economic outcomes associated with thrombolytic therapy for pulmonary embolism.

They estimated from prior literature that the rate of intracranial hemorrhage was 3 times higher with alteplase plus heparin than with heparin alone (1.2% vs. 0.4%) and that the rate…