Thrombolytic therapy for venous thromboembolism. Utilization by practicing pulmonologists

BACKGROUND: Pulmonary embolism (PE) is a potentially life-threatening condition for which thrombolytic therapy may be useful, although the appropriate setting, agent, and duration of therapy remain controversial. Deep venous thrombosis (DVT) can cause substantial morbidity and can be complicated by PE. METHODS: A questionnaire was submitted to 100 randomly selected practicing pulmonary physicians in 10 southeastern states. We sought to determine how physicians use thrombolytic therapy in PE and DVT. Characteristics of physicians, such as practice setting and the number of cases of PE and DVT treated in the last 2 years, were obtained. Physicians were asked if they would strongly consider the use of these agents in a variety of PE or DVT scenarios. RESULTS: Responses were tabulated from 56 practicing pulmonary physicians. Thirty-eight (70%) of responding physicians were in private practice. Fifty-four percent of physicians had used thrombolytic agents for acute PE, while only 28% had used them for DVT. All physicians who responded favored treating massive PE associated with hypotension with thrombolytic therapy, and 73% would strongly consider this treatment for acute PE associated with severe hypoxemia. Agreement on treatment in other scenarios was less uniform. CONCLUSIONS: Pulmonary physicians strongly favored thrombolytic therapy for massive PE associated with hypotension in the absence of absolute contraindications. A majority favored their use in PE associated with severe hypoxemia in the absence of hypotension or in massive proximal DVT present less than 7 days. Further prospective, multicenter, randomized trials appear indicated. Examining crucial end points, such as mortality, may help to unify therapeutic strategies and further refine the guidelines for the use of these agents in venous thromboembolism.