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Fibrinolytic agents, including urokinase, streptokinase and tissue plasminogen activator (t-PA), can be used to lyse thrombi in patients with acute pulmonary embolism. A patient with mild pulmonary embolism is good candidate for fibrinolytic therapy since the risk of thromboembolism recurrence is high even for this patient. A fibrinolytic agent should be administered while the thrombus is present. The most appropriate timing is when the fibrinolytic agent is administered after pulmonary perfusion and oxygenation have been restored to normal, and when the patient is hemodynamically stable. The fibrinolytic agent should be administered as soon as possible after the diagnosis is established. The dose of the fibrinolytic agent is adjusted to the patient’s body weight. The total dose of the fibrinolytic agent is at least 5 x 10(4) units of t-PA per kilogram of body weight. The total dose of urokinase is usually 1 x 10(6) units per kilogram of body weight. Most fibrinolytic agents are commercially available in the form of a lyophilized powder which should be dissolved in sterile water. If a fibrinolytic agent is dissolved in the patient’s blood, the fibrinolytic activity of t-PA is usually neutralized by the tissue plasminogen activator inhibitor (PAI). The administration of a fibrinolytic agent can be considered for patients who are not good candidates for anticoagulation or for patients who have contraindications for anticoagulant therapy. However, the dose of the fibrinolytic agent should be titrated based on the patient’s clinical condition. It is recommended that high
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