Optimal management, prevalence, and clinical behavior of saddle pulmonary embolism: A systematic review and meta-analysis

Review of Pulmonary Embolism

“…The meta-analysis cited by Xiong only suggested that a certain type of large PE (saddle PE) may not have a different prognosis than others. 5 However, that study reported a significant increased risk of death for massive PE compared with submassive and nonmassive PE (odds ratio, 29; 95% CI, 5-189), which is consistent with what was reported in our Review. Of note, that meta-analysis 5 was published after the inclusion period for articles in our Review.…”

“…Therefore, the American Thoracic Society, the American College of Obstetricians and Gynecologists, and the American Society of Hematology acknowledge that the evidence is weak but recommend lung scintigraphy over CTPA for pregnant individuals with normal chest radiography findings. 2,4,5 Conversely, the ESC believes that CTPA no longer poses the cancer risk to maternal breast tissue that it once did. 2 While this Review 1 adopted the ESC approach, it did not inform readers about this ongoing debate.…”

“…3,4 The 2019 European Society of Cardiology (ESC)/European Respiratory Society (ERS) acute PE guidelines currently recommend the use of PERTs (if available) as a class IIa recommendation. 3,5 We strongly believe that multidisciplinary PERTs may help achieve excellence in the care of patients with acute PE and anticipate full adoption by clinical practice guidelines globally in the future.…”

“…However, patients with intermediate-high-risk PE are recommended to receive LMWH anticoagulation on the first 2 to 3 days. 5 The results of the study by Chopard et al cited in the article 1 indicated that early use (within 72 hours of admission) of apixaban or rivaroxaban was associated with shorter length of hospital stay and similar low rates of death and bleeding compared with delayed use of these medications in patients with intermediate-high-risk PE. Nonetheless, the ESC/ERS guidelines recommend LMWH typically for 5 days before switching to dabigatran or edoxaban.…”

“…Nonetheless, the ESC/ERS guidelines recommend LMWH typically for 5 days before switching to dabigatran or edoxaban. 5 Because the study by Chopard et al was a retrospective post hoc analysis, and the PEITHO-2 study was a single-group noncontrolled trial, 1 use of LWMH for no more than 72 hours prior to starting direct oral anticoagulants remains questionable until higher-level evidence becomes available.…”