Thrombolytic Therapy for Deep Vein Trombosis and Pulmonary Embolisms

Although heparin remains the standard therapy for pulmonary emboli with stable hemodynamics, thrombolytic therapy is the treatment of choice for recent pulmonary embolism (maximally 14 days) and recommended in hemodynamically compromised patients. However, in deep vein thrombosis of the lower limbs, therapeutic thrombolysis is still controversial because it depends on the age and organization and localization of the thrombus. Direct intrapulmonary infusion of fibrinolytics needs lower doses than intravenous administration. Except for a few carefully selected patients with severe obstruction, thrombolytic therapy after venous thrombosis should be avoided. Right atrial or ventricular thrombi in patients with pulmonary embolism are emboli in transit and are a medical emergency because they are associated with a high mortality rate when treated conservatively with anticoagulation. Finally it should be stressed that for cases of thrombosis or emboli, careful selection should be made for thrombolytic therapy.