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Editorials |

Should Echocardiography of the Right Ventricle Help Determine Who Receives Thrombolysis for Pulmonary Embolism?

Bruce L. Davidson, MD, MPH, FCCP; Anthonie W. A. Lensing, MD, PhD
Author and Funding Information

Affiliations: Seattle, WA 
 ,  Amsterdam, The Netherlands 
 ,  Dr. Davidson is from the Pulmonary-Critical Care Medicine Section, Virginia Mason Medical Center, and is Clinical Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine; Dr. Lensing is from the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, and Clinical Development Department, NV Organon, Inc., Amsterdam, The Netherlands.

Correspondence to: Bruce L. Davidson, MD, MPH, FCCP, Pulmonary-Critical Care Medicine (C7-PUL), Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA 98101; e-mail: bruce.davidson@vmmc.org



Chest. 2001;120(1):6-8. doi:10.1378/chest.120.1.6
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Readers who think they know the answer to this question should read the carefully analyzed patient series of Hamel and colleagues published in this issue of CHEST (see page 120), and then think again.

In recent years, champions of thrombolytic therapy for patients with pulmonary embolism have identified a patient subset without gross hemodynamic compromise (shock) but having subclinical, echocardiographically identifiable, right ventricular (RV) dysfunction.13 Several articles12 have concluded that thrombolytic therapy saves lives in this group. Another thoughtful analysis4 concluded that evidence for benefit of thrombolytic therapy in the absence of shock is lacking. Can we draw a conclusion about what might be the truth? It is useful to break the question into two questions: (1) should identifying RV dysfunction (recently termed “submassive” pulmonary embolism) in the absence of shock (“massive pulmonary embolism”) make a difference in patient management, and (2) is thrombolytic therapy that difference, ie, is it a necessary-unless-contraindicated management strategy for these patients?

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