Thrombolytic Therapy for Submassive Pulmonary Embolism?

Thrombolytic therapy is recommended for hemodynamically unstable patients with pulmonary embolism (PE). However, there is no consensus on whether thrombolytic therapy is beneficial for patients with submassive PE -- that is, PE with measurable hemodynamic effects that have not resulted in clinical instability.

This double-blind, randomized German trial involved 256 patients with acute PE and right ventricular dysfunction or pulmonary hypertension (according to echocardiographic or electrocardiographic findings) but with no systemic hypotension. The patients received unfractionated heparin plus either the thrombolytic agent alteplase or placebo (given intravenously over 2 hours). The primary endpoint (in-hospital death or clinical deteriorati…