- Systemic thrombolysis using tissue plasminogen activator (tPA) is most effective if initiated early within 48 hours of onset of symptoms.
Alteplase is the only tPA approved for systemic thrombolysis in acute PE in the UK and is administered intravenously usually at a dose of 100mg over 2 hours.
After completion of systemic thrombolysis with a recombinant tPA, a heparin infusion is usually started to maintain anticoagulation.
In a cardiac arrest it has been suggested to give Alteplase 50mg IV bolus.
- Catheter-directed thrombolysis or thrombus fragmentation, suction thrombectomy, or rheolytic thrombectomy can be used in those where systemic thrombolysis is contraindicated and interventional radiology services are available.
- Surgical embolectomy can be considered in patients with inadequate response or contraindications to thrombolysis or those requiring cardiopulmonary resuscitation. This procedure can be facilitated with ECMO.
