Treatment with systemic thrombolytics is only a class I recommendation for hypotension.

May consider thrombolysis in acute pulmonary embolism with

* Per the 2011 AHA guidelines for treatment of acute PE. These are disputed as indications for thrombolytics amongst many emergency physicians. The 2016 ACCP guidelines recommend thrombolysis ONLY for hypotensive patients.
Borg score is severity of dyspnea from 0 to 10 (0 = no dyspnea, 10 = sensation of choking to death)
Per alteplase manufacturer guidelines

Absolute Contraindications:

Relative Contraindications:

 

 

Dosing of tPA (Alteplase, Activase®)

 

 

Additional medication dosing:

 

Class I evidence for aspirin, plavix, and an anticoagulant after receiving fibrinolytic therapy.

Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension. Circulation. 2011; 123: 1788-1830.

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