Pulseless, Massive and Submassive PE: Role of lytics

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:

Jeff Kline Treatment Pathway

Screenshot 2014-11-18 04.10.20

Dr. Ko’s Advice To Graduates


1. Be happy NOW.

2. Choose your passion. Find the point where your interests intersects the world's needs.

3. Define success. Figure out when you want to stop and enjoy.

4. Love others. If choosing between being nice or a jerk, be nice.

5. Enjoy the process, and focus less on the outcome.

6. Life is hard and intertwined with joy and woe.

7. Persistence is key to achieving what you really want.

8. Be thankful for everything you have and ask yourself, "How can I give back?"

9. Every day is a BRAND new day, and you can start fresh no matter what happened before.

10. Know that you will die. Think of it as the ultimate deadline. When you are worried about something, compare it to this fact.

Yours Truly,
Dr. Ko


Dr. Ko’s Advice To Graduates


1. Be happy NOW.

2. Choose your passion. Find the point where your interests intersects the world's needs.

3. Define success. Figure out when you want to stop and enjoy.

4. Love others. If choosing between being nice or a jerk, be nice.

5. Enjoy the process, and focus less on the outcome.

6. Life is hard and intertwined with joy and woe.

7. Persistence is key to achieving what you really want.

8. Be thankful for everything you have and ask yourself, "How can I give back?"

9. Every day is a BRAND new day, and you can start fresh no matter what happened before.

10. Know that you will die. Think of it as the ultimate deadline. When you are worried about something, compare it to this fact.

Yours Truly,
Dr. Ko


Dr. Ko’s Advice To Graduates


1. Be happy NOW.

2. Choose your passion. Find the point where your interests intersects the world's needs.

3. Define success. Figure out when you want to stop and enjoy.

4. Love others. If choosing between being nice or a jerk, be nice.

5. Enjoy the process, and focus less on the outcome.

6. Life is hard and intertwined with joy and woe.

7. Persistence is key to achieving what you really want.

8. Be thankful for everything you have and ask yourself, "How can I give back?"

9. Every day is a BRAND new day, and you can start fresh no matter what happened before.

10. Know that you will die. Think of it as the ultimate deadline. When you are worried about something, compare it to this fact.

Yours Truly,
Dr. Ko