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Point/Counterpoint Editorials |

Counterpoint: Should Systemic Lytic Therapy Be Used for Submassive Pulmonary Embolism? NoLytic Therapy for Pulmonary Embolism? No

Kathryn L. Bilello, MD, FCCP; Susan Murin, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr Bilello), University of California San Francisco-Fresno Program; the Department of Medicine (Dr Murin), Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine; and the Veterans Affairs Northern California Health Care System (Dr Murin).

Correspondence to: Susan Murin, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, School of Medicine, 4150 V St, Ste 3400, Sacramento, CA 95817; e-mail: susan.murin@ucdmc.ucdavis.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(2):299-302. doi:10.1378/chest.12-2449
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Extract

The outcome of acute pulmonary embolism (PE) depends on both the severity of the PE (clot burden) and the presence and severity of preexisting cardiopulmonary disease in the patient. Patients who develop shock or hypotension related to acute PE have a higher mortality than do patients with PE who are hemodynamically stable. Mortality from acute PE ranges from 70% in patients with cardiopulmonary arrest, to 30% in patients with cardiogenic shock, to 15% in patients with hypotension.1-3 Consensus guidelines recommend treatment with thrombolysis, if not contraindicated, in hemodynamically unstable patients based on their high mortality rate and the physiologic rationale that they should benefit from the more rapid dissolution of the clot and resultant relief of the vascular obstruction that is known to occur with administration of lytic agents.4,5 In contrast, patients without hypotension have a mortality ranging from 0% to 10%,1,6 and guidelines recommend that they be treated with anticoagulation alone.4,5

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