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Concern about intracranial hemorrhage limits the use of tissue plasminogen activator (TPA) in the treatment of submassive pulmonary embolism (PE). Researchers prospectively randomized 121 adults with symptomatic moderate PE to receive “safe dose” TPA plus anticoagulation with heparin or enoxaparin (thrombolysis group) or anticoagulation alone (control group).
“Safe dose” TPA was defined as 50 mg administered as a 10-mg bolus followed by a 40-mg infusion within 2 hours (or 0.5 mg/kg total dose for patients weighing <50 kg). Moderate PE was defined as >70% involvement of thrombus in at least two lobes or left or right main pulmonary arteries shown on angiography, or a high probability ventilation/perfusion scan showing mismatch in at least two…