BMJ Case Reports 2013; doi:10.1136/bcr-2012-007549

Thrombolysis in submassive pulmonary embolism, prudent or puerile?

  1. Atul Chugh2
  1. 1Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
  2. 2University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Dr Aamer Rehman, a0rehm01{at}


Pulmonary embolism (PE) remains one of the leading causes of cardiovascular mortality. The safety and efficacy of thrombolytic therapy using tissue-type plasminogen activator (tPA) for acute PE in clinical practice remain unclear. We describe a case of life-threatening submassive PE causing extreme refractory hypoxaemia, where thrombolysis was successfully administered. Current consensus suggests that patients with features of hemodynamic instability as a result of an acute PE, that is, massive PE, should receive thrombolysis. Patients, not in shock however, but with evidence of right-ventricular (RV) dysfunction echocardiographically, that is, submassive PE may also benefit. Serum troponin and brain-type natriuretic peptide have been suggested as biomarkers of RV injury that may identify a subset of submassive PE patients who may particularly benefit from thrombolytic therapy. The clinical response of this patient to thrombolysis is important, as it may identify a subgroup of patients with submassive PE who warrant this intervention.

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