ÎIn patients with acute PE associated with hypotension (eg, systolic BP < 90 mm Hg) who do not have a high bleeding risk, the ACCP suggests systemically administered thrombolytic therapy over no such therapy (2-C).
ÎIn patients with acute PE associated with hypotension and who have
• contraindications to thrombolysis • failed thrombolysis • shock that is likely to cause death before systemic thrombolysis can take effect (eg, within hours)
if appropriate expertise and resources are available, the ACCP suggests catheter-assisted thrombus removal over no such intervention (2-C).
ÎIn most patients with acute PE not associated with hypotension, the ACCP recommends AGAINST systemically administered thrombolytic therapy (1-C).
ÎIn patients with acute PE, when a thrombolytic agent is used, the ACCP suggests short infusion times (eg, a 2-h infusion) over prolonged infusion times (eg, a 24-h infusion) (2-C).
ÎIn patients with acute PE when a thrombolytic agent is used, the ACCP suggests administration through a peripheral vein over a pulmonary artery catheter (2-C).
ÎIn patients with PE who undergo thrombolysis, the ACCP recommends the same intensity and duration of anticoagulant therapy as in similar patients who do not undergo thrombolysis (1-B).
ÎIn patients with acute PE who are treated with anticoagulants, the ACCP recommends AGAINST the use of an IVC filter (1-B).
ÎIn patients with acute PE and contraindication to anticoagulation, the ACCP recommends the use of an IVC filter (1-B).
ÎIn patients with acute PE and an IVC filter inserted as an alternative to anticoagulation, the ACCP suggests a conventional course of anticoagulant therapy if their risk of bleeding resolves (2-B).
Remark: The ACCP does not consider that a permanent IVC filter, of itself, is an indication for extended anticoagulation.
ÎIn patients with PE provoked by surgery or a nonsurgical transient risk factor, the ACCP recommends treatment with anticoagulation for 3 months over
• treatment for a shorter period (1-B) • treatment for a longer time-limited period (eg, 6 or 12 months) (1-B) or • extended therapy (1-B regardless of bleeding risk).
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