Massive Pulmonary Embolism: Short-Term Effects of Thrombolytic Treatment

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Abstract
This study assessed the short-term effects of thrombolytic treatment in 38 patients with massive pulmonary embolism. Thirty-two were treated with strep tokinase and six with urokinase. Intrapulmonary artery instillation of fibrino lytic agents was utilized except in 3 patients. There was a marked hemodynamic and arteriographic improvement (p < 0.0005) in 33 patients (86.8%). Four pa tients (10.5%) died because of treatment failure. In these cases the fibrinogen concentration remained above 1 gr/liter during therapy. Bleeding was detected in 22 patients (57.8%) but was most often related to puncture or cut-down sites, and only 2 patients (5.2%) had major bleeding. One patient (2.6%) had cerebral hemorrhage. It is concluded that "classic" thrombolytic treatment is to be cho sen in life-threatening pulmonary embolism. However, the difficulties some times encountered in producing an intense lytic effect and its low fibrinolytic specificity for the thrombus do not permit the obtainment of better results.