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Guidelines recommend that patients with massive pulmonary embolism (PE) and hemodynamic instability be treated with thrombolysis (Circulation 2011; 123:1788). However, consensus is lacking on what to do in intermediate-risk patients (i.e., those who are hemodynamically stable but have right ventricular dysfunction). Investigators performed a meta-analysis of 16 trials conducted during the last 45 years of thrombolysis for PE. Of 2115 patients, most (71%) were classified as having intermediate-risk PE; 9.9% had low-risk PE; and 1.5% had hemodynamically unstable, high-risk PE. Risk could not be classified in the remaining patients.
At mean follow-up of 82 days, all-cause mortality was significantly lower overall in patients who received thromb…