Management of Pulmonary Embolism

Konstantinides, Stavros; Barco, Stefano; Lankeit, Mareike; Meyer, Guy

doi:10.1016/j.jacc.2015.11.061

Cited by 276 publications

(222 citation statements)

References 97 publications

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“…Therapeutic AC is the cornerstone of acute PE management . It is therefore critically important that the chosen method of AC is both reliable and effective in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin

Prucnal

Jansson

Deadmon

et al. 2019

Academic Emergency Medicine

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Objective The objective was to determine the proportion of patients with pulmonary embolism (PE) treated with unfractionated heparin (UFH) who achieved therapeutic activated partial thromboplastin time (aPTT) values within 48 hours of treatment. Methods Retrospective analysis of a PE response team (PERT) database was performed at a large, urban, academic teaching hospital. Inclusion criteria were adult patients with acute PE for whom the PERT was consulted and who received anticoagulation (AC) with UFH according to guideline standard dosing. aPTT values during 6‐hour time periods during the first 48 hours of AC were collected and analyzed. Results A total of 505 patients met inclusion criteria. For patients receiving a bolus and infusion of UFH, the proportions (95% confidence interval [CI]) of patients in the therapeutic range were 19.0% (14.2% to 25.0%) at 12 hours, 26.3% (26.3% to 33.1%) at 24 hours, 28.3% (22.0% to 35.4%) at 36 hours, and 28.4% (20.8% to 37.5%) at 48 hours. For titrated infusion only, the proportions (95% CIs) of patients were 23.3% (16.2% to 32.3%) at 12 hours, 41.4% (31.6% to 51.9%) at 24 hours, 37.0% (26.8% to 48.5%) at 36 hours, and 42.1% (30.2% to 55.0%) at 48 hours. No patient had all therapeutic aPTT values. Conclusions The majority of patients with acute PE spend most of their first 48 hours outside of the therapeutic range of AC when treated with guideline standard dosing of UFH. Over half of the patients fail to achieve any therapeutic PTT level within 24 hours of UFH initiation, and no patient had all therapeutic aPTTs. Future research should focus on identifying factors associated with achieving therapeutic AC with UFH.

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“…Therapeutic AC is the cornerstone of acute PE management . It is therefore critically important that the chosen method of AC is both reliable and effective in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin

Prucnal

Jansson

Deadmon

et al. 2019

Academic Emergency Medicine

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“…For example, there may be a progressive increase in HR, a decrease in systolic BP (which remains >90 mmHg), an increase in jugular venous pressure, worsening gas exchange, signs of shock (e.g., cold sweaty skin, reduced urine output, confusion), progressive right heart dysfunction on echocardiography, or an increase in cardiac biomarkers (12). However, thrombolytic therapy is not warranted in most cases in abscense of hypotension (5,(12)(13)(14). Few studies, only case series and retrospective studies, have compared thrombolysis with surgical therapy in acute PE and recommended to consider surgical pulmonary embolectomy in case of hypotension and contraindication for thrombolysis or life-threatening situations like failure of thrombolysis, RV failure, cardiogenic shock and TT (3,12,15,16).…”

Section: Treatmentmentioning

confidence: 99%

Early surgical treatment in patients with pulmonary embolism and thrombus-in-transit

Galeano‐Valle

Demelo‐Rodríguez

García-Fernández-Bravo

et al. 2018

J. Thorac. Dis.

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Background: Floating right heart thrombi (RHT) are in transit from the legs to the pulmonary arteries and thus are a severe form of venous thromboembolism (VTE), with a high early mortality rate without treatment. There is a lack of evidence-based recommendations for its management. The objective of this study is to describe our experience in the surgical management of thrombus-in-transit and pulmonary embolism (PE) in a tertiary hospital. Methods: We recruited four patients with thrombus-in-transit and PE treated with early surgical embolectomy and anticoagulation. Epidemiologic, laboratory, imaging and clinical data of the thromboembolic episode and the subsequent course were collected. Results: The sample included 3 males and 1 female, with a mean age of 49.7. The most frequent initial symptoms were dyspnea, syncope, chest pain and signs of deep vein thrombosis (DVT). Transthoracic echocardiogram (TTE) found the thrombus-in-transit in all the cases. The inicial treatment was unfractionated heparin (UFH) and urgent right atriectomy and manual removal of the thrombi. Three patients needed perioperative infusion of vasopressor drugs. All patients had right heart dysfunction at the time of diagnosis. The mean scoring in the Pulmonary Embolism Severity Index (PESI) was 90. All patients survived after 30 days of follow-up. Conclusions: Early surgical embolectomy of thrombus-in-transit is an effective option of management in selected patients, although the current evidence to support this approach is not definitive.

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“…1,2 There are several risk stratification models for this purpose. 1,2 There are several risk stratification models for this purpose.…”

Section: Introductionmentioning

confidence: 99%

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment

Erol

Kaya

Ciftci

et al. 2016

Clinical Respiratory J

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Management of Pulmonary Embolism

Cited by 276 publications

References 97 publications

Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin

Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin

Early surgical treatment in patients with pulmonary embolism and thrombus-in-transit

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment

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