Authors

• Karlo Golubić — Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia — ORCID: 0000-0003-0684-6333
• Nikola Kos — Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia — ORCID: 0000-0001-8829-2543
• Tonći Batinić — Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia — ORCID: 0000-0002-8431-6963
• Mislav Vrsalović — Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia — ORCID: 0000-0002-8432-404X

Abstract

Pulmonary embolism remains the one of the commonest cardiovascular disease, the severity of which is variable and can be lethal. The incidence is expected to increase due to the aging population. Intermediate-high risk pulmonary embolism is characterized by hemodynamical stability, but elevated mortality risk and both radiographic and laboratory signs of right heart strain. Thrombolysis remains a possible life saving treatment option but bears an increased risk of potentially life-threatening hemorrhage. Optimal treatment is still not established. (1-3) We present a series of intermediate-high risk patients treated in our hospital with thrombolytic therapy (n=4, 2 male, median age 58.5) and compare relevant direct and indirect values of right ventricular load before and after treatment (**Table 1**). We also provide a summary of our clinical approach in light of current guidelines and two meta-analyses. ### TABLE 1: Comparison of relevant direct and indirect values of right ventricular load before and after treatment. | **Before treatment** | **Before treatment** | **Before treatment** | **After treatment** | **After treatment** | **After treatment** | | --- | --- | --- | --- | --- | --- | | **SO2 (%)** | **TnI (ng/L)** | **NTproBNP (ng/L)** | **SO2 (%)** | **TnI (ng/L)** | **NTproBNP (ng/L)** | | 80 | 657 | 6103 | 98 | 35 | 83 | | 82 | 61 | 3522 | 92 | <10 | 145 | | 84 | 190 | 9122 | 97 | 262 | 2976 | | 94 | 125 | 2597 | 96 | <10 | 139 |

Keywords

pulmonary embolism, thrombolytic therapy

DOI

Literature

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2. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA. 2014 June 18;311(23):2414–21. https://doi.org/10.1001/jama.2014.5990
3. Zuo Z, Yue J, Dong BR, Wu T, Liu GJ, et al. Thrombolytic therapy for pulmonary embolism. Cochrane Database Syst Rev. 2021 April 15;4(4):CD004437. https://doi.org/10.1002/14651858.CD004437.pub6