R.E.B.E.L.EM - Posted by Salim Rezaie - November 3, 2016
"Clinical BOTTOM LINE:
- There is not a clear cut answer based on the available evidence, but with a shared decision making strategy, consideration of patient age (≥65 years vs <65 years) and functional status considerations, some generalizations can be made:
- Full dose systemic thrombolysis is effective BUT has a high bleeding complication rate. Acceptable /Unacceptable bleeding rates should be discussed on a case by case basis with patients using a shared decision making strategy
- Low dose systemic thrombolysis has less bleeding with equal efficacy compared to full dose systemic thrombolysis, however more data is needed on mortality outcomes. This may be a good strategy in patients over the age of 65 years who have increased risk of major bleeding and ICH.
- The evidence for CDT is very scant and not compared to systemic thrombolysis, but it does appear to be more expensive and cause longer length of ICU stay compared to systemic thrombolysis. This may be another option to consider in patients with increased risk of bleeding (i.e. Patients 65 years and older) while balancing cost and use of resources
- CDT and low dose systemic thrombolysis improve symptoms, hemodynamics, RV/LV size, other echo parameters and PA pressures, but long-term clinical correlates are still lacking"