Acute Care MedicineEmergency MedicineEvidence Based MedicineSMACCSubmassive PE should be Thrombolysed

Submassive PE should be Thrombolysed: Anand Swaminathan and Iain Beardsell

Anand Swaminathan and Iain Beardsell debate the use of thrombolytics in the treatment of submassive pulmonary embolism (PE).

PE is a spectrum of disease. Patients should be treated differently depending on where they are on the spectrum.

Subsegmental PE may need no treatment at all, whereas massive PE is unlikely to improve without thrombolytics.

Anand argues for the use of thrombolytics.

Evidently, time is critical when dealing with patients and Anand posits that thrombolytics gives the physician control over time.

Submassive PE can deteriorate, leading to massive pulmonary embolism. A proportion of these patients will die. The data is not conclusive for the use of thrombolytics in terms of mortality, however long term outcomes do improve.

Finally, Anand concludes by suggesting that the decision to use thrombolytics relies on sound clinical reasoning and decision making, informed by the available data. He argues for nuanced treatments and use of these drugs.

Iain takes a different approach in his reply.

Some of the most difficult topics in medicine attract considerable debate. The use of thrombolysis for submassive PE is one of these.

In this argument Iain attempts to highlight some of the most pertinent evidence against the use of thrombolysis. And he does so through song!

Submassive PE should be Thrombolysed: Anand Swaminathan and Iain Beardsell

For more like this, head to our podcast page. #CodaPodcast

Iain Beardsell

Consultant in Emergency Medicine at @uhsft and Pre Hospital Doctor with @hiowaa. DipIMC. Enthusiastic supporter of #FOAMed via @stemlyns


Anand Swaminathan

Anand Swaminathan is a core faculty member of the St. Joseph’s Regional Medical Center Emergency Department in Paterson, NJ. He is an assistant professor of Emergency Medicine at the Hackensack Meridian School of Medicine and the Medical Education Fellowship Director at St. Joseph’s Hospital. His main interests are in resident education, faculty development, resuscitation and knowledge translation. Anand is the managing editor and conference chair for EM: RAP and the managing editor for EM Abstracts. He is a big believer in and contributor to the Free Open Access Medical Education (FOAM) movement. Anand is an associate editor for REBEL EM and REBELCast and a regular contributor to the EM Cases Quick Hits podcast. When not working, Anand enjoys long distance running and building Legos with his kids (Matt 12, Maya 9 and Luke 5).