447. Pulmonary Embolism: Approach to Systemic Thrombolysis in Acute Pulmonary Embolism with Dr. Allison Burnett

Systemic thrombolysis remains a critical, life-saving intervention for high-risk pulmonary embolism (PE) patients, though its use requires rigorous risk stratification due to significant bleeding risks, including a roughly 2% rate of intracranial hemorrhage. While meta-analytic data supports mortality benefits in massive PE, this advantage is less clear in intermediate-risk cases. Dr. Allison Burnett, an antithrombosis stewardship pharmacist, highlights that tenecteplase is increasingly favored over alteplase for its bolus administration ease, despite ongoing debates regarding optimal dosing and concomitant anticoagulation protocols. Multidisciplinary Pulmonary Embolism Response Teams (PERT) improve decision-making speed and resource allocation, facilitating individualized care. Anticoagulation strategies during lytic therapy lack universal consensus, necessitating institutional protocols that balance the need for rapid, predictable anticoagulation—often using low molecular weight heparin—with the specific requirements of advanced procedures like catheter-directed thrombectomy or ECMO.