Thrombolysis as an alternative to pulmonary embolectomy.

In the past two decades an abundance of medical literature has been published describing the incidence, diagnosis, natural history, and treatment of pulmonary embolism. From this wealth of data, diagnostic and therapeutic trends are emerging which will likely have great influence on the future management of patients with pulmonary embolism. A clinician treating patients with suspected pulmonary embolism is first confronted by the need to establish a firm diagnosis and then to choose between three primary treatment modalities anticoagulation with heparin, thrombolytic therapy with urokinase or streptokinase, or pulmonary embolectomy. This brief review attempts to describe the magnitude of the clinical problem and to provide background data on the various treatment modalities. A detailed discussion of diagnostic studies is not within the scope of this paper.