TY - CHAP M1 - Book, Section TI - Thrombolytic Therapy for Submassive Pulmonary Embolism A1 - Beri, Samarth A1 - Pastores, Stephen M. A2 - Oropello, John M. A2 - Pastores, Stephen M. A2 - Kvetan, Vladimir PY - 1 T2 - Critical Care AB - KEY POINTSAcute pulmonary embolism (PE) is the most frequent and potentially fatal venous thromboembolic event.Clinically, acute PE can be classified as either massive or submassive. Thrombolytic therapy is the recommended treatment for patients with acute massive PE who are hemodynamically unstable and do not have a high bleeding risk.In patients with submassive PE, the use of thrombolytic therapy remains controversial.Risk stratification with echocardiography may assist when deciding to use thrombolytic therapy for hemodynamically stable patients with submassive PE and evidence of right ventricular (RV) dysfunction.Echocardiographic findings in patients with acute PE include RV hypokinesis and dilatation, interventricular septal flattening and paradoxical motion toward the left ventricle, tricuspid regurgitation, pulmonary hypertension and loss of inspiratory collapse of the inferior vena cava.The hemodynamic status of the patient with acute PE is the most significant predictor of mortality in the short term.Among patients with submassive PE being treated with unfractionated heparin, the administration of tenecteplase reduced the composite endpoint of all-cause mortality or hemodynamic decompensation at 7 days when compared to placebo but was associated with an increased rate of bleeding. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1136418266 ER -