Thrombolytic Therapy for Pulmonary Embolism



Absolute Contraindications


         Stroke, cerebrovascular events or head trauma within 1 year

         Previous intracranial hemorrhage

         Active internal bleeding

         Intracranial neoplasm, arteriovenous malformation, or aneurysm

         Suspected aortic dissection




Relative Contraindications (Note: these should not preclude the use of thrombolytic therapy in a patient in whom the diagnosis is secured, as the treatment may be life sustaining.)


Patient history


         Major surgery or other serious trauma in previous 2 weeks

         GI or GU bleeding in prior 3 weeks

         Arterial puncture at a noncompressible site within 1 week

         Lumbar puncture within 1 week

         Administration of heparin within previous 48 hours and with elevated aPTT

         Concurrent administration of warfarin and with elevated PT

         Pregnant or lactating patient

         Active menstrual bleeding

         History of prior cerebrovascular accident or known intracerebral pathology not covered in absolute contraindications

         History of chronic, severe hypertension



Clinical features


         Systemic hemorrhage

         Unexplained anemia

         Findings consistent with acute MI or post-MI pericarditis

         High likelihood of left heart thrombus e.g., mitral stenosis with atrial fibrillation

         Subacute bacterial endocarditis

         Hemostatic defects including those secondary to severe hepatic or renal disease

         Significant liver dysfunction

         Diabetic hemorrhagic retinopathy, or other hemorrhagic ophthalmic conditions

         Septic thrombophlebitis or occluded AV cannula at seriously infected site

         Advanced age, (i.e., over 75 years old)

         Known bleeding diathesis

         Any other condition in which bleeding constitutes a significant hazard or would be particularly difficult to manage



Laboratory results


         Platelet count <100,000 / mm3

         APTT above normal range (see patient history for heparin use above)

         INR > 1.7 (see patient history for warfarin use above)