American Board of Internal Medicine (ABIM) Certification Practice Exam

What criterion does the American College of Chest Physicians (ACCP) recommend for thrombolytic therapy in PE?

1. Systolic blood pressure below 100 mm Hg

2. Systolic blood pressure less than 90 mm Hg without contraindications

3. Severe dyspnea present

4. High risk of recurrent thromboembolism

The correct answer is: Systolic blood pressure less than 90 mm Hg without contraindications

The American College of Chest Physicians (ACCP) recommends that thrombolytic therapy for pulmonary embolism (PE) should be considered in patients who present with hypotension, specifically if their systolic blood pressure is less than 90 mm Hg without any contraindications for therapy. This recommendation is based on the understanding that patients with severe hypotension due to PE are at a higher risk of adverse outcomes, and thrombolytic therapy can rapidly dissolve the clot, restore blood flow, and improve hemodynamic stability. In cases of systolic blood pressure less than 90 mm Hg, the risk of shock or death increases significantly, making it imperative to initiate prompt treatment. This criterion focuses on the urgency and potential reversibility of hemodynamic compromise, which emphasizes the importance of timely intervention in high-risk patients. The other options, while potentially indicative of a need for treatment or concern, do not specifically align with the established guideline criterion for thrombolytic therapy as critically as this specific hypotension threshold.