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Coda Change

Jan 22, 2017

Anand Swaminathan and Iain Beardsell debate the use of thrombolytics in the treatment of submassive pulmonary embolism (PE).

PE is a spectrum of disease. Patients should be treated differently depending on where they are on the spectrum.

Subsegmental PE may need no treatment at all, whereas massive PE is unlikely to improve without thrombolytics.

Anand argues for the use of thrombolytics.

Evidently, time is critical when dealing with patients and Anand posits that thrombolytics gives the physician control over time.

Submassive PE can deteriorate, leading to massive pulmonary embolism. A proportion of these patients will die. The data is not conclusive for the use of thrombolytics in terms of mortality, however long term outcomes do improve.

Finally, Anand concludes by suggesting that the decision to use thrombolytics relies on sound clinical reasoning and decision making, informed by the available data. He argues for nuanced treatments and use of these drugs.

Iain takes a different approach in his reply.

Some of the most difficult topics in medicine attract considerable debate. The use of thrombolysis for submassive PE is one of these.

In this argument Iain attempts to highlight some of the most pertinent evidence against the use of thrombolysis. And he does so through song!

Submassive PE should be Thrombolysed: Anand Swaminathan and Iain Beardsell

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