- Some argue in favour of thrombolysis given improved longer-term outcomes:
- Reduced burden of chronic RV failure or thrombus-related pulmonary hypertension
- Others argue against thrombolysis given:
- Relatively low mortality rates even with standard treatment (heparin)
- Lack of proven mortality benefit (PEITHO trial used composite endpoint of mortality and haemodynamic instability)
- Known potential for serious morbidity/ mortality with thrombolytics (mainly due to intracranial bleeding)
- Increased cost
- European Society of Cardiology guidelines do not currently recommend thrombolysis for intermediate-risk (sub-massive) pulmonary embolism
