Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

Abstract

Submassive pulmonary embolism (PE) remains a vexing entity, and the appropriate use of thrombolytic therapy for this subgroup continues to be actively debated. Catheter-directed thrombolysis has shown efficacy for submassive PE and is gaining momentum because of theoretically improved safety. This review poses and responds to four questions that explore the complex issues surrounding optimal therapy of submassive PE.

Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

“…7 It should be mentioned that since this registry data, several randomized control trials have demonstrated significantly lower 90-day mortality rates for submassive PE (2-3%). 8…”

“…Determining which submassive PE patients should be considered for escalation of therapy is an ongoing research topic. 8 The ESC system of stratifying intermediate PE patients Fig. 3 Results from PERFECT, SEATTLE II, and ULTIMA trials demonstrating similar mean systolic pulmonary artery pressures, at baseline and after intervention with CDT.…”

“…Repetition of a short-term trial, with only enough patients to demonstrate a difference in a physiologic parameter, would not influence current practice. 8 Future research is also needed to define and standardize the CDT protocol in submassive PE patients. The ideal and maximum thrombolytic dose, as well as catheter-directed techniques and device superiority, needs to be further delineated.…”

How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey

“…The optimal management of submassive pulmonary embolism (PE) is uncertain. Submassive PE is associated with a higher rate of clinical deterioration and mortality compared to low-risk PE when treated with anticoagulation alone [1,2,3,4]. Survivors may also suffer from a long-term “post-PE syndrome” (PPS) and chronic thromboembolic pulmonary hypertension (CTEPH), characterized by decreased exercise tolerance and quality of life [5,6].…”

“…Targeted delivery of a low-dose thrombolytic drug into the clot through a multi-side hole catheter could mitigate the risk of major bleeding complications while achieving better drug effectiveness [8]. However, CDT’s efficacy and safety have been inadequately evaluated [1,2,9,10,11].…”