Pulmonary Embolism Treatment
- Exclude contraindications.
- 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.
- 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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