Review of Medical Therapies for the Management of Pulmonary Embolism

Abstract

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.

In situ Pulmonary Artery Thrombosis: A Previously Overlooked Disease

“…Second, for the thrombotic patients without an obvious trigger or with an irremovable trigger, anticoagulation is a must. For instance, although balloon pulmonary angioplasty (BPA) is an effective interventional modality for the patients with CTEPH, especially for the CTEPH patients with thrombi in the distal pulmonary arteries, the oral anticoagulant drugs such as warfarin, should be maintained lifetime to prevent recurrence of CTEPH following BPA ( Panahi et al, 2021 ).…”

Trauma-induced pulmonary thromboembolism: What's update?

“…A therapeutic dose of anticoagulants should be used timely if there is no anticoagulant contraindication ( Table 2 ). 72 , 73 , 74 , 75 , 76 , 77 Systematic thrombolytic therapy, such as, recombinant tissue type plasminogen activator (r-tPA), 50 mg intravenous infusion for 2 h, is recommended only for patients at a high risk of PTE. 70 For trauma patients with contraindications to systemic thrombolysis, pulmonary interventional thrombolysis, or thrombus aspiration can be considered, even under the condition that extracorporeal membrane oxygenation was needed for help.…”

“…Both low dose unfractionated heparin (5000U Q12H) and LMWH (30 mg Q12H) enoxaparin administered after trauma can effectively prevent the occurrence of VTE and be safely adjusted based on the anti-Xa levels. 72 , 103 Weight-based and blood for the anti-Xa testing should be typically drawn 4 h after the third dose of enoxaparin, that with the target prophylactic levels falling in the range of 0.2–0.4 IU/mL (the target for therapeutic full anticoagulation is > 0.5 IU/mL) is recommended. But one larger retrospective study 104 reported no decrease in VTE rates with an anti-Xa-based regimen.…”

Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism - from Modern Recommendations to Clinical Application

“…The oral bioavailability is approximately 50%, with most of the drug absorption occurring in the small intestine [115]. Drug elimination occurring via the metabolism through the CYP3A4 systems in the intestine and liver and the P-glycoprotein system can be enhanced through drug-drug interactions Apixaban [116].…”