Major pulmonary embolism, part 3: Treatment strategy thrombolysis is preferred over surgery

The outcome for patients with pulmonary embolism (PE) is determined largely by the size of the embolism as well as the patient's underlying cardiopulmonary status. Therapeutic approaches include medical embolectomy with thrombolytic agents, but it is important that therapy be individualized to suit different patient needs. Although patients with major PE are not a well-studied group, hemodynamic instability is a common denominator. Clot lysis is achieved more rapidly with thrombolytic therapy than with heparin alone. Surgical embolectomy is indicated rarely, for patients in whom thrombolytic therapy clearly has failed or who cannot tolerate such therapy. Catheter embolectomy is an alternative for patients who are not in full cardiac arrest. The standard therapeutic approach to emboli in transit and isolated right ventricular dysfunction remains a challenge.