Role of thrombolysis in haemodynamically stable patients with pulmonary embolism

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Abstract
The justification for considering thrombolysis in this group is based on the knowledge that mortality rates double in patients who have PE with preserved haemodynamic status but evidence of right heart dilatation.2 7 RV compromise is perceived to be a sign of possible impending haemodynamic instability and is a common cause of death. While case series suggest that RV dysfunction is present in up to 50% of patients with haemodynamically stable PE at presentation,2 7 mortality data for such patients treated with heparin alone ranges from 0% to almost 30%.7–9 In contrast, it is clear from case series that patients with haemodynamic stability and a normal right heart on transthoracic echo have a mortality approaching 0% with appropriate anticoagulation.7 10 The challenge is therefore to identify the subgroup of patients with normotension who are likely to progress to RV failure and haemodynamic instability where the inherent risks of thrombolytic therapy may be justifiable.

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