CONTEMPORARY PULMONARY-EMBOLISM THROMBOLYSIS

Thrombolysis debulks clot and provides primary treatment of pulmonary embolism, whereas intensive anticoagulation is critical for secondary prevention of recurrent pulmonary embolism. The decision to use primar y therapy or secondary prevention depends upon the patient's risk of s uffering an adverse clinical outcome. We utilize echocardiography to h elp risk-stratify our patients. The presence of normal right ventricul ar function portends an excellent prognosis with anticoagulation alone . In contrast, the presence of right ventricular hypokinesis or dilata tion may indicate a high likelihood of recurrent pulmonary embolism de spite adequate anticoagulation. Among high risk patients, thrombolysis can usually rapidly reverse right heart failure and be life-saving. T he procedure for administering thrombolytic therapy has been streamlin ed to improve efficacy, enhance safety, and reduce costs. (C) 1998 Els evier Science ireland Ltd.