Chulalongkorn Medical Journal


Background : The use of thrombolytic therapy in patients with submassive pulmonaryembolism (PE) is still controversial.Objective : To evaluate the role of thrombolytic therapy in patients with submassivePE.Design : Systematic review.Setting : Faculty of Medicine, Chulalongkorn University.Methods : We performed a literature search using Pubmed, Scopus, scientificabstracts from meetings, and bibliographies of retrieved articles. Onlyrandomized control trials were included in this systematic review.Result : Three randomized control trials were identified. All these studies excludedpatients with high risk of bleeding. The evidence from randomized controltrials identified in this systematic review suggested that thrombolytictherapy in addition to heparin may provide a long-term mortality benefit,prevent clinical deterioration, and preserve right ventricular function with aslightly increased risk of minor bleeding in patients with submassive PE.The benefits of thrombolytic therapy were most obvious in a randomizedcontrol trial that enrolled patients within 6 hours after the onset of thesymptoms.Conclusion : Thrombolytic therapy may be considered in patients with submassive PEwho have low risk of bleeding complications and present early afterthe onset of the symptoms.


Faculty of Medicine, Chulalongkorn University

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