ABSTRACT
The initial treatment of DVT and PE is the same: either unfractionated heparin or low-molecular-weight heparin.25 The suggestive evidence that the prognosis for long-term survival and recurrent VTE is worse with patients presenting with PE than DVT may be a reason to treat patients presenting with PE more aggressively in the future, but, at present, the anticoagulant management is identical.26,27 A selected group of patients with acute massive or submassive PE may be candidates for thrombolysis. A recent study has shown that heparin plus alteplase was significantly better than heparin plus placebo in increasing the probability of event-free survival (with ‘event’ being defined as in-hospital death or clinical deterioration requiring an escalation of treatment after termination of the infusion of the study drug).28 However, as with previous trials of thrombolysis in acute PE, there was no significant decrease in mortality with the use of thrombolysis. Except for patients who present with an acute episode of isolated femoral or ileofemoral DVT, there are no indications for thrombolysis in the treatment of DVT.29
