Thrombolytic Therapy for Pulmonary Embolism:  Is It Effective? Is It Safe? When Is It Indicated?

James E. Dalen, MD, MPH; Joseph S. Alpert, MD; Jack Hirsh, MD
Arch Intern Med. 1997;157(22):2550-2556. doi:10.1001/archinte.1997.00440430026003.
Text Size: A A A
Published online

MORE than 30 years after the first clinical reports of thrombolytic therapy for the treatment of acute pulmonary embolism (PE)1,2 its indications still remain uncertain. The most widely accepted indication for thrombolytic therapy for PE is in patients with hypotension secondary to massive PE.3 However, the number of patients with PE who present with shock and who do not have 1 or more contraindications to thrombolytic treatment is very small.

The first 2 thrombolytic agents that were approved by the Food and Drug Administration (FDA) for the treatment of acute PE were streptokinase (1977) and urokinase (1978). These 2 agents were compared with heparin in 2 randomized clinical trials.4,5

The successful results of recombinant tissue-type plasminogen activator (rt-PA) in the treatment of acute myocardial infarction led to its evaluation for the treatment of acute PE. The first report of rt-PA in the treatment of PE by Bounameaux


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 108

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.