Intermediate-Risk Patients with PE Should Receive Thrombolytics Only If They Decompensate

Administration of thrombolytic therapy for acute pulmonary embolism (PE) requires weighing the substantial risk of hemorrhage against the potential benefits, mainly improved hemodynamics and reduced mortality. For patients in shock with clear evidence of PE (high risk), the benefits seem to outweigh the risks, but for hemodynamically stable patients with evidence of right ventricular dysfunction and elevated troponin levels (intermediate risk), the evidence has been less clear. To determine the safety and efficacy of thrombolytic therapy in intermediate-risk patients, researchers in France performed a multicenter, randomized, double-blind trial comparing tenecteplase plus heparin with placebo plus heparin in 1005 hemodynamically stable pati…