THROMBOLYTIC THERAPY IN PULMONARY EMBOLISM

Despite major advances in prevention, diagnosis and treatment of pulmonary thromboembolism (PTE), it remains a major health problem worldwide. The current knowledge of the pathophysiology of PTE provides the basis for identifying right ventricular dysfunction (RVD) as the most important clinical expression for a diagnosis stratification approach of patients at low risk, without RVD, that could benefit with anticoagulation alone (secondary prevention) or those at high risk, with RVD, that require rapid lysis by fibrinolytic therapy, surgical or catheter embolectomy. This context raises the questions of what have we learned from clinical trials with fibrinolytic therapy, what is the rationale for the use of fibrinolytic therapy plus heparin in PTE, what is the clinical evidence that supports their use, and what are the recommendations that arise in relation to pathogenesis and degree of pulmonary vascular obstruction.