Pulmonary Embolism Treatment

Systemic Thrombolysis

 - Exclude contraindications.

 - Indications:

   - Massive PE (definite indication)

   - High-risk submassive PE (risk/benefit)

 - Std dose alteplase = 100mg IV over 2 hrs

 - Low dose 0.5 mg/kg (up to 50mg IV)

 - 2% risk of ICH and 6% risk of other major bleeding with tPA (PIETHO)

Catheter Directed Lysis

 - Useful in patients who are higher risk for thrombolysis. May be superior to anticoag alone-in intermediate risk PE.

Embolectomy

 - May be useful in patients who fail above therapies, who have C/I to thrombolysis, or who require surgery for large RA thrombus



Nick Mark MD @nickmmark



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