Thrombolysis for postoperative pulmonary embolism: limiting the risk of haemorrhage

Even with postoperative thromboprophylaxis, 1% of patients will develop venous thromboembolism following elective arthroplasty. Of this number, 5% will suffer a fatal pulmonary embolism (PE).1 Where massive PE occurs causing right ventricular hypokinesis and shock, the mortality may be in excess of 30%.2 British Thoracic Society guidelines recommend thrombolysis for massive PE but, following major surgery, the risk of bleeding is significant and many clinicians would hesitate to expose their patient to this. Here we suggest a novel method …