Which PEs may be candidates for thrombolysis?
We do not suggest that all minor pulmonary emboli be treated with thrombolysis. Well-tolerated PEs have an extremely good prognosis when treated with heparin.1–,3 Furthermore, thrombolysis does have some inherent risk, particularly of haemorrhage. There is marked variability in the reported incidence of major haemorrhage in studies. This is often defined as fatal haemorrhage, intracranial haemorrhage (ICH), or bleeding that requires either surgery or transfusion. A recent review of studies comparing thrombolytic and heparin therapy showed mean incidences of major haemorrhage of 6.3% and 1.8%, respectively, and of ICH, 1.2% and 0%, respectively.5 However, the randomized study by Konstantinides et al. showed no increase in the incidence of major bleeding in 256 patients randomized to receive heparin and thrombolysis or heparin and placebo. There were no cases of intracranial haemorrhage in either group, and the only fatal bleed was in the non-thrombolysed group.14 It is possible that we
