Pulmonary embolism goes unrecognised in many patients, but most patients in whom it is diagnosed are treated by i.v. heparin for 3–7 days followed by an oral anticoagulant. This regimen aims to prevent extension of the embolus and further peripheral thrombosis during the period of physiological fibrinolysis. In the minority of patients who have massive embolism and shock, pulmonary embolectomy should be considered.1 An alternative approach is the use of a thrombolytic drug to accelerate the lysis of pulmonary emboli before starting treatment with heparin or considering embolectomy. Two thrombolytic enzymes, streptokinase and urokinase, are marketed for this purpose.
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