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Pulmonary vascular disease
Review
Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: a hypothesis paper
  1. Paul Abraham1,2,
  2. Diego A Arroyo1,2,3,
  3. Raphael Giraud1,2,
  4. Henri Bounameaux4 and
  5. Karim Bendjelid1,2
  1. 1Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
  2. 2Geneva Hemodynamic Research Group, Geneva, Switzerland
  3. 3Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
  4. 4Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
  1. Correspondence to Professor Karim Bendjelid; karim.bendjelid{at}hcuge.ch

Abstract

While systemic intravenous thrombolysis decreases mortality in patients with high-risk pulmonary embolism (PE), it clearly increases haemorrhagic risk. There are many contraindications to thrombolysis, and efforts should aim at selecting those patients who will benefit most, without suffering complications. The current review summarises the evidence for the use of thrombolytic therapy in PE. It clarifies the pathophysiological mechanisms in PE and acute cor pulmonale that increase the risk of bleeding following thrombolysis. It discusses future management challenges, namely tailored drug administration, new treatment monitoring techniques and catheter-directed thrombolysis.

  • myocardial ischaemia and infarction (ihd)
  • pulmonary embolism
  • thrombolytic therapy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000735

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    Footnotes

    • PA and DAA contributed equally.

    • Contributors PA and DAA contributed equally. Both designed, drafted the manuscript and collected the data. KB designed the manuscript and made critical revisions for important intellectual content. HB and RG made critical revisions for important intellectual content. All authors read and approved the final manuscript.

    • Competing interests RG received consultant fees from BTG for a presentation at the Pulmonary Embolism Expert Forum (PEEF) in 2017.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.