In intermediate-risk PE, when is reperfusion therapy considered?

• A. Immediately at diagnosis
• B. If there is clinical deterioration
• C. After 72 hours if no improvement
• D. Never; only anticoagulation

Answer: (B)

In intermediate-risk pulmonary embolism, you start with anticoagulation and monitor closely because these patients are not hypotensive, but they do have signs of right heart strain. Reperfusion therapy is not given immediately to everyone in this category because thrombolysis carries a significant bleeding risk. It is considered when the patient shows clinical deterioration—meaning worsening cardiovascular status despite anticoagulation, such as developing hypotension or shock, increasing oxygen needs, or signs of progressive right ventricular failure. In that scenario, rapid clot-busting treatment (systemic or catheter-directed thrombolysis) can be life-saving. The timing isn’t at diagnosis for all intermediates, and waiting 72 hours isn’t the standard approach unless deterioration occurs; and while anticoagulation alone is appropriate for stable cases, there is a role for reperfusion if the clinical course worsens.