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The only FDA-approved thrombolytic drug for the treatment of pulmonary embolism is tPA. Current studies (including studies by Jeff Kline-"Dr. PE") are investigating the use of TNKase and other agents. For hemodynamically unstable PE (hypotension, RV dysfunction): tPA- give 100 mg over two hours as a drip (no bolus). Heparin must be stopped during infusion and restarted after the tPA has finished. More on serum markers of RV dysfunction next week...