Recommendation ID
CG144/5
Question
Systemic pharmacological thrombolysis compared with standard anticoagulation treatment in patients with pulmonary embolism and right ventricular dysfunction:- What is the clinical and cost effectiveness of systemic pharmacological thrombolysis compared with standard initial anticoagulation therapy in patients with confirmed PE and haemodynamic stability who present with right ventricular dysfunction?
Any explanatory notes
(if applicable)
Why this is important:- It is unclear from the evidence identified in the review whether there are subgroups of patients with PE and haemodynamic stability who have a significant risk of PE-related mortality and morbidity and who would benefit from systemic thrombolysis. No evidence was found in the clinical review for the safety and effectiveness of pharmacological thrombolysis in patients with confirmed PE and haemodynamic stability who present with right ventricular dysfunction. An RCT is needed to compare pharmacological thrombolysis (for example, with alteplase) with standard initial anticoagulation therapy (with LMWH or fondaparinux) in these patients. The important outcomes would be all-cause mortality, VTE-related mortality, cardiopulmonary resuscitation, major bleeding, VTE recurrence and chronic thromboembolic pulmonary hypertension. This research could improve early outcomes and survival, and reduce complications such as chronic thromboembolic pulmonary hypertension, and would inform an update of this guideline. Currently the guideline does not recommend systemic thrombolysis for these patients.

Source guidance details

Comes from guidance
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
Number
CG144
Date issued
June 2012

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 10/07/2012