Table 2.

How to administer fibrinolytic therapy for submassive pulmonary embolism (PE).

Initiate anticoagulation with intravenous unfractionated heparin bolus and continuous infusion with a target activated partial thromboplastin time (aPTT) of 60-80 seconds as soon as submassive pulmonary embolism (PE) is suspected Stop heparin infusion when issuing the order to administer fibrinolysis Infuse recombinant tissue plasminogen activator (t-PA) 100 mg over two hours with careful monitoring for bleeding complications, including neurological checks every 15 minutes during the infusion Obtain immediate post-fibrinolytic infusion aPTT After the fibrinolytic infusion has concluded, do not restart heparin until the aPTT is less than 80 seconds