Contemporary pulmonary embolism thrombolysis

Thrombolysis debulks clot and provides primary treatment of pulmonary embolism, whereas intensive anticoagulation is critical for secondary prevention of recurrent pulmonary embolism. The decision to use primary therapy or secondary prevention depends upon the patient's risk of suffering an adverse clinical outcome. We utilize echocardiography to help risk-stratify our patients. The presence of normal right ventricular function portends an excellent prognosis with anticoagulation alone. In contrast, the presence of right ventricular hypokinesis or dilatation may indicate a high likelihood of recurrent pulmonary embolism despite adequate anticoagulation. Among high risk patients, thrombolysis can usually rapidly reverse right heart failure and be life-saving. The procedure for administering thrombolytic therapy has been streamlined to improve efficacy, enhance safety, and reduce costs. (C) 1998 Elsevier Science ireland Ltd.