Management of pulmonary thrombo-embolism using catheter manipulation: a report of four cases and review of the literature

To date the management of pulmonary thrombo-embolism is still largely limit ed to anticoagulation. Heparin and oral anticoagulation have been shown to be effective in reducing recurrence and death in venous thrombo-embolism. D uring the acute stage, systemic thrombolytic therapy has also been advocate d for the rapid dissolution of the thrombus in patients with haemodynamic i nstability. We describe four patients with acute pulmonary thrombo-embolism who were managed with catheter-based thrombus manipulation with intrapulmo nary thrombolysis. This management strategy should be considered in patient s with pulmonary thrombo-embolism who continue to deteriorate despite conve ntional management with anticoagulation or systemic thrombolysis.