Weigh Thrombolytic Pros and Cons for Submassive Pulmonary Embolism

We're getting questions about using SYSTEMIC thrombolytics to treat "submassive," or intermediate-risk, pulmonary embolism (PE).

We know to give a systemic thrombolytic for most hemodynamically unstable, or "massive," PE patients...and to hold off for mild PEs.

But those in the middle are trickier. "Submassive" PE patients have systolic BP above 90 mmHg but right ventricular dysfunction on CT or echo...or elevated troponins or BNP.