Advanced Treatment of Hemodynamically Unstable Acute Pulmonary Embolism and Clinical Follow-up

Abstract

High-risk acute pulmonary embolism (PE), defined as acute PE associated with hemodynamic instability, remains a significant contributor to cardiovascular morbidity and mortality in the United States and worldwide. Historically, anticoagulant therapy in addition to systemic thrombolysis has been the mainstays of medical therapy for the majority of patients with high-risk PE. In efforts to reduce the morbidity and mortality, a wide array of interventional and surgical therapies has been developed and employed in the management of these patients. However, the most recent guidelines for the management of PE have reserved the use of these advanced therapies in scenarios where thrombolytic therapy plus anticoagulation are unsuccessful. This is due largely to the lack of prospective, randomized studies in this population. Stemming from this, the approach to treatment of these patients varies widely depending on institutional experience and resources. Furthermore, morbidity and mortality remain unacceptably high in this population, with estimated 30-day mortality of at least 30%. As such, development of a standardized approach to treatment of these patients is paramount to improving outcomes. Early and accurate risk stratification in conjunction with a multidisciplinary team approach in the form of a PE response team is crucial. With the advent of novel therapies for the treatment of acute PE, in addition to the growing availability of and familiarity with mechanical circulatory support systems, such a standardized approach may now be within reach.

Optimizing and Extending the Risk-Adapted Management of Acute Pulmonary Embolism beyond the Acute Phase: Progress in Pulmonary Embolism Research

“…Dr. Fulton and coauthors stress the need for a standardized treatment approach, emphasizing the importance of early risk assessment and multidisciplinary teams such as a Pulmonary Embolism Response Team, also in light of the growing expertise in mechanical circulatory support systems and progressively increasing spectrum of treatment modalities. 1 In the same topic, Dr. Bejjani and colleagues discuss right ventricular failure as a critical issue in PE and as the key tool to refine risk assessment for consideration of treatments. 2 This review highlights the impact of PE on right ventricular dysfunction, guiding early risk assessment, acute treatment, and long-term care.…”