Which reperfusion therapy is recommended for a PE of moderate to high risk?

• A. tPA (thrombolytic therapy)
• B. Heparin infusion
• C. Aspirin therapy
• D. Mechanical ventilation

Answer: (A)

When a pulmonary embolism is moderate to high risk, the priority is rapid restoration of blood flow to relieve right ventricular strain and improve survival. Thrombolytic therapy with tissue plasminogen activator dissolves the clot quickly, directly addressing the obstruction and improving hemodynamics. This makes it the best choice for reperfusion in high-risk PE, provided there are no contraindications to thrombolysis.

Anticoagulation with heparin is essential to prevent further clotting, but it does not rapidly dissolve the existing embolus. Aspirin has no role in acute PE management and does not dissolve clots. Mechanical ventilation is supportive for breathing or shock but does not reperfuse the clot. In selected cases where thrombolysis is contraindicated, alternatives like catheter-directed therapy or surgical embolectomy may be considered, but the standard reperfusion option here is thrombolysis with tPA.