Contemporary classification of acute pulmonary embolism (PE) severity is based on the risk of early death, which is influenced by demographic factors, comorbidity, and the functional status of the right ventricle (RV) under acute pressure overload [1]. Shock or persistent arterial hypotension, indicating overt RV failure at presentation, has long been identified as a key determinant of poor prognosis [2] and represents the only widely accepted indication for (systemic) thrombolytic therapy to date [3]. In contrast, for normotensive patients who present with imaging findings that indicate RV dysfunction and biochemical evidence of myocardial injury, anticoagulation remains the primary treatment option [3, 4]. This recommendation is supported by the Pulmonary Embolism Thrombolysis (PEITHO) trial, which showed that patients fulfilling these latter criteria were unlikely to derive a net clinical benefit from routine use of systemic thrombolysis in view of the high risk for major bleeding [5]. Defining a “higher-risk” population among intermediate-risk patients with pulmonary embolism included in PEITHO http://ow.ly/JM7u30hcSgN

中文翻译：

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改进对中危肺栓塞患者溶栓候选者的识别：对未来试验的影响

急性肺栓塞 (PE) 严重程度的现代分类基于早期死亡的风险，后者受人口因素、合并症和急性压力超负荷下右心室 (RV) 的功能状态的影响 [1]。休克或持续性动脉低血压表明就诊时明显 RV 衰竭，长期以来一直被认为是预后不良的关键决定因素 [2]，并且是迄今为止（全身）溶栓治疗唯一被广泛接受的适应症 [3]。相比之下，对于血压正常的患者，影像学检查结果表明 RV 功能障碍和心肌损伤的生化证据，抗凝治疗仍然是主要的治疗选择 [3, 4]。该建议得到肺栓塞溶栓 (PEITHO) 试验的支持，这表明，鉴于大出血的高风险，满足后一标准的患者不太可能从常规使用全身溶栓治疗中获得净临床益处 [5]。在 PEITHO http://ow.ly/JM7u30hcSgN 中定义肺栓塞中危患者中的“高危”人群