Reduced-Dose Thrombolysis in Acute Pulmonary Embolism A Systematic Review

Pulmonary embolism (PE) is the third-leading cause of cardiovascular mortality and the second-leading cause of death in cancer patients. The clinical efficacy of thrombolysis for acute PE has been proven, yet the therapeutic window seems narrow, and the optimal dosing for pharmaceutical reperfusion therapy has not been established. Higher doses of systemic thrombolysis inevitably associated with an incremental increase in major bleeding risk. To date, there is no high-quality evidence regarding dosing and infusion rates of thrombolytic agents to treat acute PE. Most clinical trials have focused on thrombolysis compared with anticoagulation alone, but dose-finding studies are lacking. Evidence is now emerging that lower-dose thrombolytic administered through a peripheral vein is efficacious in accelerating thrombolysis in the central pulmonary artery and preventing acute right heart failure, with reduced risk for major bleeding. The present review will systematically summarize the current evidence of low-dose thrombolysis in acute PE.

Automated summary

Pulmonary embolism (PE) is a significant cause of mortality, particularly in cancer patients. Although thrombolysis has shown efficacy in treating acute PE, the optimal dosage and infusion rates have not been established. Higher doses of systemic thrombolysis come with an increased risk of major bleeding. However, evidence suggests that low-dose thrombolysis administered via a peripheral vein can effectively accelerate thrombolysis and reduce the risk of major bleeding in acute PE.