PE is a spectrum of disease and patients on different parts of the spectrum should be treated differently. Subsegmental PE may need no treatment at all whereas massive PE is unlikely to improve without lytics. Between these ends of the spectrum lies the submassive PE – hemodynamically stable but with signs of RV strain portending worse long-term functional outcomes for patients and possible early deterioration. These patients should all be considered for systemic thrombolysis to improve outcomes.
Some of the most difficult topics in medicine attract considerable debate, The use of thrombolysis for submassive PE is one of these. In this “Con” argument I attempt to highlight some of the most pertinent evidence against the use of thrombolysis.