Follow-up after acute Pulmonary Embolism

Klok, Frederikus A.

doi:10.5482/hamo-17-06-0020

Cited by 35 publications

(11 citation statements)

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“…Third, PE mortality was highest among older adults in both high‐ and low‐income states, which highlights the paucity of higher‐quality thrombosis management studies in the elderly. Finally, in addition to abating the burden of VTE‐associated death, broad improvements in the management of VTE will also benefit VTE survivors suffering from the long‐term limitations and symptoms collectively referred to as “post‐VTE syndrome.” 40 …”

Section: Discussionmentioning

confidence: 99%

“…Finally, in addition to abating the burden of VTE-associated death, broad improvements in the management of VTE will also benefit VTE survivors suffering from the long-term limitations and symptoms collectively referred to as "post-VTE syndrome." 40 Although the GBD 2019 does not report data for VTE as a specific cause of death and disability, 14 VTE is responsible for a substantial burden of disease across the globe. The WHO patient safety program 14 found that VTE accounted for more deaths than any other hospital-acquired disease in low-, middle-, and high-income states.…”

Section: Discussionmentioning

confidence: 99%

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Global reporting of pulmonary embolism–related deaths in the World Health Organization mortality database: Vital registration data from 123 countries

Valerio

Gallo

Turatti

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Introduction Pulmonary embolism (PE) has not been accounted for as a cause of death contributing to cause‐specific mortality in global reports. Methods We analyzed global PE‐related mortality by focusing on the latest year available for each member state in the World Health Organization (WHO) mortality database, which provides age‐sex–specific aggregated mortality data transmitted by national authorities for each underlying cause of death. PE‐related deaths were defined by International Classification of Diseases, Tenth Revision codes for acute PE or nonfatal manifestations of venous thromboembolism (VTE). The 2001 WHO standard population served for standardization. Results We obtained data from 123 countries covering a total population of 2 602 561 422. Overall, 50 (40.6%) were European, 39 (31.7%) American, 13 (10.6%) Eastern Mediterranean, 13 (10.6%) Western Pacific, 3 (2.4%) Southeast Asian, and 2 (1.6%) African. Of 116 countries classifiable according to population income, 57 (49.1%) were high income, 42 (36.2%) upper‐middle income, 14 (12.1%) lower‐middle income, and 3 (2.6%) low income. A total of 18 726 382 deaths were recorded, of which 86 930 (0.46%) were attributed to PE. PE‐related mortality rate increased with age in most countries. The reporting of PE‐related deaths was heterogeneous, with an age‐standardized mortality rate ranging from 0 to 24 deaths per 100 000 population‐years. Income status only partially explained this heterogeneity. Conclusions Reporting of PE‐related mortality in official national vital registration was characterized by extreme heterogeneity across countries. These findings mandate enhanced efforts toward systematic and uniform coverage of PE‐related mortality and provides a case for full recognition of PE and VTE as a primary cause of death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Global reporting of pulmonary embolism–related deaths in the World Health Organization mortality database: Vital registration data from 123 countries

Valerio

Gallo

Turatti

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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“…Частота ХТЭЛГ после симптоматической ТЭЛА варьирует от 0,1% до 11,8%, в большинстве исследований -2-4%. Применение для диагностики ХТЭЛГ в опубликованных исследованиях только ЭхоКГ в 3 раза увеличивает частоту суждений о наличии данного осложнения после ТЭЛА [33].…”

Section: хроническая тромбоэмболическая легочная гипертензияunclassified

Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism

Клименко

Демидова

Шостак

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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After suffering pulmonary embolism (PE), doctors are confronted with various consequences of the disease, from asymptomatic residual pulmonary thrombosis to the formation of chronic thromboembolic pulmonary hypertension (CTEPH). There is also a subgroup of patients who have undergone pulmonary embolism, who experience shortness of breath during physical exertion, absent before pulmonary embolism, or shortened dyspnea preceding PE, combined with residual thrombosis of pulmonary artery (PA) and normal average pressure in PA at rest during catheterization of the right heart (CRH). This condition is defined as chronic thromboembolic pulmonary disease or post thromboembolic syndrome. Pathogenetic aspects of this condition are not fully investigated. It is important to predict the development of postembolic syndrome and to develop algorithms for the diagnosis, treatment and rehabilitation of patients with symptoms and residual pulmonary thrombosis. In case of the development of pulmonary vasculopathy in some patients who have undergone pulmonary embolism, a severe life-threatening condition forms - CTEPH, characterized by an increase in pressure in the pulmonary artery, right heart failure due to the presence of organized blood clots that have entered the pulmonary vascular bed during PE. The volume of thrombotic masses does not always correlate with clinical symptoms, which indicates the importance of microvascular remodeling. If CTEPH is suspected, a diagnostic algorithm is required, including ventilation-perfusion scintigraphy, CT angiopulmonography and catheterization of the right heart. Treating a patient with CTEPH is a difficult task fora doctor. The timely referral of the patient to the center where they are involved in treatment, including surgery and CTEPH is extremely important. Timely performed thrombendarterectomy in some cases allows to completely cure the patient. In the case of inoperable CTEPH or residual pulmonary hypertension after thrombendarterectomy, balloon angioplasty of the PA is used as well as drug treatment with specific drugs that reduce the pressure in the PA (riociguat), endothelin receptor antagonists (bosentan, macitentan), prostanoids (inhalant illoprost) phosphodiesterase-5 inhibitor and combined therapy. In this article we considered some consequences directly related to PE: asymptomatic residual pulmonary thrombosis, chronic thromboembolic pulmonary disease, chronic thromboembolic pulmonary hypertension.

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“…Post-PE syndrome (or post-PE impairment) is emerging as an important late complication of acute PE that affects the perceived burden of disease, risk of recurrence, quality of life, and healthcare expenditures 45 . It is defined as the combination of clinical, imaging, and haemodynamic signs of functional impairment that are highly prevalent in PE survivors.…”

Section: Long-term Outcomes After Reperfusion Therapymentioning

confidence: 99%

Immediate and late impact of reperfusion therapies in acute pulmonary embolism

Valerio

Klok

2019

European Heart Journal Supplements

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Haemodynamic instability and right ventricular dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). Residual thrombi and persistent right ventricular dysfunction may contribute to post-PE functional impairment, and influence the risk of developing chronic thromboembolic pulmonary hypertension. Patients with haemodynamic instability at presentation (high-risk PE) require immediate primary reperfusion to relieve the obstruction in the pulmonary circulation and increase the chances of survival. Surgical removal of the thrombi or catheter-directed reperfusion strategies is alternatives in patients with contraindications to systemic thrombolysis. For haemodynamically stable patients with signs of right ventricular overload or dysfunction (intermediate-risk PE), systemic standard-dose thrombolysis is currently not recommended, because the risk of major bleeding associated with the treatment outweighs its benefits. In such cases, thrombolysis should be considered only as a rescue intervention if haemodynamic decompensation develops. Catheter-directed pharmaco-logical and pharmaco-mechanical techniques ensure swift recovery of echocardiographic and haemodynamic parameters and may be characterized by better safety profile than systemic thrombolysis. For survivors of acute PE, little is known on the effects of reperfusion therapies on the risk of chronic functional and haemodynamic impairment. In intermediate-risk PE patients, available data suggest that systemic thrombolysis may have little impact on long-term symptoms and functional limitation, echocardiographic parameters, and occurrence of chronic thromboembolic pulmonary hypertension. Ongoing and future interventional studies will clarify whether ‘safer’ reperfusion strategies may improve early clinical outcomes without increasing the risk of bleeding and contribute to reducing the burden of long-term complications after intermediate-risk PE.

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Follow-up after acute Pulmonary Embolism

Cited by 35 publications

References 98 publications

Global reporting of pulmonary embolism–related deaths in the World Health Organization mortality database: Vital registration data from 123 countries

Global reporting of pulmonary embolism–related deaths in the World Health Organization mortality database: Vital registration data from 123 countries

Thrombotic Lesion of the Pulmonary Vessels in Patients with Pulmonary Embolism

Immediate and late impact of reperfusion therapies in acute pulmonary embolism

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