Time-based reperfusion in hemodynamically unstable pulmonary embolism patients: Does early reperfusion therapy improve survival?

High-risk pulmonary embolism (PE) is associated with significant morbidity and mortality. Systemic thrombolysis (ST) remains the most evidenced-based treatment for hemodynamically unstable PE but, in daily clinical practice, it remains largely underused. In addition, unlike acute myocardial infarction or stroke, a clear time window for reperfusion therapy, including fibrinolysis, for high-risk PE has not been defined either for fibrinolysis, or for the more recently incorporated options of catheter-based thrombolysis or thrombectomy. The aim of the present article is to review the current evidence supporting the potential benefit of earlier administration of reperfusion in hemodynamically unstable PE patients and suggest some potential strategies to further explore this issue.