PULMONARY EMBOLISM-THROMBOLYSIS

SUMMARY

1. Streptokinase, tPA, and other thrombolytics are indicated for patients with massive PE who have "acceptable" risks of bleeding.

2. Thrombolysis (Systemic or Catheter-directed): in massive PE only if BP less than 90 systolic or at high risk of developing hypotension.

3. IVC Filter. Indications: recent surgery, haemorrhagic CVA, active bleeding, massive PE where recurrent embolism would be fatal, recurrent PE despite adequate anticoagulation. May need removal after 3 months.

4. Pulmonary Embolectomy: if contraindications to thrombolysis.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].