We should probably be lysing more PEs.
Update, Sept 2010
Piazza et al. Management of Submassive Pulmonary Embolism. Circulation. 2010;122:1124-1129.
Here we have a different definition of massive vs. submassive:
“Patients with acute PE who have normal systemic arterial pressure and preserved RV function have an excellent prognosis with therapeutic anticoagulation alone. In contrast, patients with massive PE present with syncope, systemic arterial hypotension, cardiogenic shock, or cardiac arrest and have an increased risk of adverse outcomes, including death. Normotensive patients with acute PE and evidence of RV dysfunction are classified as having submassive PE, constitute a large population at increased risk for adverse events…”
So these authors suggest that PE+hypotension=massive=reperfusion therapy. For PE+normotension, they offer this algorithm:
So +biomarker is a requirement reperfusion. They also present a concise summary of how to lyse: