TY - JOUR
T1 - Clinical controversies in the management of acute pulmonary embolism
T2 - evaluation of four important but controversial aspects of acute pulmonary embolism management that are still subject of debate and research
AU - Luijten, Dieuwke
AU - Klok, Frederikus A.
AU - van Mens, Thijs E.
AU - Huisman, Menno V.
N1 - Funding Information: FA Klok reports grants or contracts from Bayer, BMS, BSCI, MSD, Leo Pharma, Actelion, Pharm-X, The Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Association, The Dutch Heart Foundation, and the Horizon Europe Program, all unrelated to this work and paid to his institution. MV Huisman reports grants from The Netherlands Organisation for Health Research and Development (ZonMW) and Dutch Heart Foundation, grants from Boehringer-Ingelheim, grants from Pfizer-BMS, and grants from Bayer Health Care all outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Publisher Copyright: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023
Y1 - 2023
N2 - Introduction: Acute pulmonary embolism (PE) is a disease with a broad spectrum of clinical presentations. While some patients can be treated at home or may even be left untreated, other patients require an aggressive approach with reperfusion treatment. Areas covered: (1) Advanced reperfusion treatment in hemodynamically stable acute PE patients considered to be at high risk of decompensation and death, (2) the treatment of subsegmental pulmonary embolism, (3) outpatient treatment for hemodynamically stable PE patients with signs of right ventricle (RV) dysfunction, and (4) the optimal approach to identify and treatpost-PE syndrome. Expert opinion: Outside clinical trials, hemodynamically stable acute PE patients should not be treated with primary reperfusion therapy. Thrombolysis and/or catheter-directed therapy are only to be considered as rescue treatment. Subsegmental PE can be left untreated in selected low-risk patients, after proximal deep vein thrombosis has been ruled out. Patients with an sPESI or Hestia score of 0 criteria can be treated at home, independent of the presence of RV overload. Finally, health-care providers should be aware of post-PE syndrome and diagnose chronic thromboembolic pulmonary disease (CTEPD) as early as possible. Persistently symptomatic patients without CTEPD benefit from exercise training and cardiopulmonary rehabilitation.
AB - Introduction: Acute pulmonary embolism (PE) is a disease with a broad spectrum of clinical presentations. While some patients can be treated at home or may even be left untreated, other patients require an aggressive approach with reperfusion treatment. Areas covered: (1) Advanced reperfusion treatment in hemodynamically stable acute PE patients considered to be at high risk of decompensation and death, (2) the treatment of subsegmental pulmonary embolism, (3) outpatient treatment for hemodynamically stable PE patients with signs of right ventricle (RV) dysfunction, and (4) the optimal approach to identify and treatpost-PE syndrome. Expert opinion: Outside clinical trials, hemodynamically stable acute PE patients should not be treated with primary reperfusion therapy. Thrombolysis and/or catheter-directed therapy are only to be considered as rescue treatment. Subsegmental PE can be left untreated in selected low-risk patients, after proximal deep vein thrombosis has been ruled out. Patients with an sPESI or Hestia score of 0 criteria can be treated at home, independent of the presence of RV overload. Finally, health-care providers should be aware of post-PE syndrome and diagnose chronic thromboembolic pulmonary disease (CTEPD) as early as possible. Persistently symptomatic patients without CTEPD benefit from exercise training and cardiopulmonary rehabilitation.
KW - Pulmonary embolism
KW - anticoagulants
KW - outpatient care
KW - pulmonary hypertension
KW - therapeutic thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85150874243&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/17476348.2023.2190888
DO - https://doi.org/10.1080/17476348.2023.2190888
M3 - Article
C2 - 36912598
SN - 1747-6348
VL - 17
SP - 181
EP - 189
JO - EXPERT REVIEW OF RESPIRATORY MEDICINE
JF - EXPERT REVIEW OF RESPIRATORY MEDICINE
IS - 3
ER -