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Letters |15 April 1995

Risks for Bleeding in Patients with Pulmonary Embolism Treated with Thrombolytic Agents

Paul D. Stein; Russell D. Hull; Gary Raskob

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • University of California, San Diego, Medical Center, San Diego, CA 92103-8372. Department of Veterans Affairs Medical Center, New Orleans, LA 70146. Merrithew Memorial Hospital, Martinez, CA 94553. Union Hospital, Lynn, MA 01904. Henry Ford Heart and Vascular Institute, Detroit, MI 48202-2691.
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IN RESPONSE:
We appreciate the thoughtful letters about our article [1]. Although a difference of opinion appears to exist, our article may have been misinterpreted. We did not imply that we favor a broader use of thrombolytic drugs for patients with acute pulmonary embolism. Our purpose was to assess the relative risks of thrombolytic therapy administered on the basis of an invasive compared with a noninvasive diagnosis. The physician must determine the indications for thrombolytic therapy.
The indications that we use, hypotension or hypoxia while the patient is receiving high doses of oxygen or echocardiographic evidence of right ventricular failure, are guidelines that assist in identifying patients who may not survive the acute episode of pulmonary embolism. Perhaps unstable patients may do better with open embolectomy, catheter-tip embolectomy, or catheter-tip fragmentation than with thrombolytic therapy. Regardless, if a physician selects thrombolytic therapy as the treatment of choice, our data allow assessment of the risks for major complications of thrombolytic therapy administered on the basis of an invasive or noninvasive diagnosis.
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Stein PD, Hull RD, Raskob G. Risks for Bleeding in Patients with Pulmonary Embolism Treated with Thrombolytic Agents. Ann Intern Med. ;122:630–632. doi: 10.7326/0003-4819-122-8-199504150-00019

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Published: Ann Intern Med. 1995;122(8):630-632.

DOI: 10.7326/0003-4819-122-8-199504150-00019

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