Thrombolytic therapy in pulmonary embolism.

Successfully utilized contemporary pulmonary embolism (PE) thrombolysis reverses right heart failure rapidly and safely. This therapeutic approach may lower mortality from PE and reduce morbidity from chronic pulmonary hypertension. PE thrombolysis remains a debatable indication because large clinical trials using survival as an endpoint have not been carried out. Instead, thrombolysis trials have been undertaken with surrogate endpoints such as reduction in clot burden, reduction in pulmonary arterial pressure, and improvement in right ventricular function. Currently, the only contemporary thrombolytic regimen for PE that is approved by the Food and Drug Administration is recombinant tissue plasminogen activator, in a dose of 100 mg/2 h. New thrombolytic agents under development for PE include reteplase, saruplase, and recombinant staphylokinase. Future clinical trials will require multicenter collaboration and focus on clinically relevant endpoints such as reduction of mortality and recurrent venous thromboembolism, under particular consideration of the risk of intracranial hemorrhage that ranges between about 1.7% in clinical trials up to approximately 3.0% in a large registry.