For a patient with a large saddle pulmonary embolus, what is the preferred thrombolytic therapy?

For a patient with a large saddle pulmonary embolus, the preferred thrombolytic therapy is 100 mg of alteplase administered over 2 hours. This dosing and administration method is typically used for treating more extensive thromboembolic events due to its effectiveness in rapidly dissolving large clots and restoring pulmonary blood flow.

The 100 mg dose over 2 hours provides a balance between efficacy and safety. Administering the drug over a longer period rather than as a bolus reduces the risk of complications such as hemorrhage while allowing sustained therapeutic levels of the medication to act on the clot. This method increases the likelihood of successful thrombolysis without overwhelming the patient's system with a single, high dose.

In contrast, options including a 50 mg bolus or doses given as immediate bolus injections may not be sufficient for effective treatment in cases of significant pulmonary embolism, where a more aggressive approach is warranted. Utilizing intraosseous administration, as referenced in one of the other choices, would not be standard practice for systemic thrombolysis in this scenario, as intravenous administration allows for better distribution and faster action in the vascular system.

Thus, selecting the appropriate dose and administration route is crucial for maximizing therapeutic outcomes in the treatment of large saddle