Thrombolysis for Submassive Pulmonary Embolism

Thrombolytic therapy is clearly beneficial for patients with massive pulmonary embolism (PE) and hemodynamic instability, but the benefits for hemodynamically stable patients with submassive PE are unclear. In this industry-supported trial from Germany, researchers prospectively enrolled 256 patients (maximum age, 80) with PE and pulmonary hypertension or right-ventricular dysfunction but without persistent arterial hypotension (systolic blood pressure, <90 mm Hg) or contraindications to thrombolysis. Within 96 hours of symptom onset, subjects were randomized either to unfractionated heparin (UFH) plus alteplase (100 mg over 2 hours) or to UFH plus placebo.

The primary endpoint (in-hospital death or clinical deterioration that required rescu…