Developments in the management and treatment of pulmonary embolism

Abstract

Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach. Individual risk stratification directs initial treatment. Rates of recurrence differ between subgroups of patients with PE; therefore, a review of provoking factors, along with the risks of morbidity and bleeding, guides the duration of ongoing anticoagulation. The direct oral anticoagulants have shown similar efficacy and, in some cases, reduced major bleeding compared with standard approaches for acute treatment. They also offer the potential to reduce the burden on patients and outpatient services in the post-hospital phase. Rivaroxaban, dabigatran and apixaban have been shown to reduce the risk of recurrent venous thromboembolism versus placebo, when given for >12 months. Patients receiving direct oral anticoagulants do not require regular coagulation monitoring, but follow-up, ideally in a specialist PE clinic in consultation with primary care providers, is recommended. @ERSpublications Direct oral anticoagulants have the potential to improve management of patients with pulmonary embolism http://ow.ly/NV7K6

Prothrombotic Fibrin Clot Phenotype Is Associated With Recurrent Pulmonary Embolism After Discontinuation of Anticoagulant Therapy

“…23 Our study confirmed that in patients with unprovoked PE, the risk of recurrence is markedly higher than in those with provoked VTE, which agrees with other studies. 24 Elevated D-dimer after anticoagulation withdrawal also predicted PE recurrence in our study like in many others. 5,6,18,19 Elevated CRP, indicating enhanced systemic inflammation, has been shown in patients at risk of VTE 25 ; however, we did not observe higher CRP in subjects with recurrent PE.…”

Do radiologists detect chronic thromboembolic disease on computed tomography?

“…The mortality rate in APE differs from >15% in haemodynamically unstable patients, 3-15% in intermediate risk patients with right ventricular dysfunction or myocardial damage and <1% in low risk patients (18). This indicates the importance of distinguishing the relatively small group of haemodynamically unstable high-risk patients from the normotensive intermediate-or low-risk patients (18,19).…”

Pulmonary embolism occuring in the patient who treated by spinal cord stimulation

“…[4] The combination of clinical probability estimation, CTPA, and serum D-dimer levels is usually used to establish the diagnosis. [5] Dyspnea, tachypnea, chest pain, cough, hemoptysis, tachycardia, syncope, and respiratory crepitations are common symptoms of PE, but none of these is unique to the condition.…”

“…Syncope or near syncope, hypotension, extreme hypoxemia, electromechanical dissociation , or cardiac arrest is suggestive of a massive PE. [4] Pulmonary embolism is a potentially fatal condition if left untreated. [6,7] Its presentation can be relatively mild, sometimes even mimicking myalgia or a simple cough.…”

“…Many fatal cases are not diagnosed premortem because of the nonspecific clinical symptoms with which patients often present. [4] Pulmonary embolism may occur without any predisposing factors. However, one or more factors may be determined, for instance, conditions that require patients to lie for a long time, such as old age, venous thromboembolism, active cancer, paresis, cardiac disease, respiratory insufficiency, congenital or acquired thrombophilia, and use of the oral contraceptive.…”