Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Jay Metzger


anticoagulation; prognosis; pulmonary embolism; thrombectomy; thrombolytics


Acute massive pulmonary embolism is characterized by obstruction of the pulmonary arterial tree that exceeds 50% of the cross-sectional area causing acute and severe cardiopulmonary failure from right ventricular overload. Systemic thrombolytic therapy is recommended as standard, first-line treatment in patients with massive pulmonary embolism unless contraindicated and catheter directed therapies, including low dose thrombolytic administration directly into thrombus and mechanical thrombectomy can be adjunctive or used as an alternative to systemic treatments. This literature review researched articles looking both systemic thrombolysis and endovascular techniques for the treatment of acute massive pulmonary embolism with an emphasis on long term clinical outcomes. Study results demonstrated the efficacy and safety of systemic thrombolysis and catheter directed therapies as well as adverse effects; however, further randomized trials are needed, as acknowledged by many of the authors included in this paper, comparing both treatment options for hemodynamically unstable patients with emphasis on long term sequalae.