[Translated article] Multidisciplinary consensus for the management of pulmonary thromboembolism

Lobo, José Luís; Alonso, Sergio; Arenas, Juan; Domènech, Pere Pascual i; Escribano, Pilar; Fernández‐Capitán, Carmen; Jara-Palomares, Luis; Jiménez, Sònia; Lázaro, María; Monreal, Manuel; Ruiz-Artacho, Pedro; Jiménez, David

doi:10.1016/j.arbres.2021.01.038

Cited by 11 publications

(12 citation statements)

References 36 publications

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“…Estimation of prognosis helps with prioritization of appropriate management strategies. [11][12][13] Studies have shown that risk stratification and use of a management pathway for hospitalized patients with acute PE reduces the length of hospital stay without compromising safety, 14 and this might be associated with improved short-term survival. 15 Overall, most patients treated with anticoagulant therapy (i.e., low-and intermediate-lowrisk PE, according to the European Society of Cardiology [ESC] risk stratification 13 ) survive and do not have a recurrent event or a major complication associated with therapy.…”

Section: Introductionmentioning

confidence: 99%

Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence

Chopard,

Morillo,

Meneveau

et al. 2024

Hamostaseologie

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High-risk pulmonary embolism (PE) refers to a large embolic burden causing right ventricular failure and hemodynamic instability. It accounts for approximately 5% of all cases of PE but contributes significantly to overall PE mortality. Systemic thrombolysis is the first-line revascularization therapy in high-risk PE. Surgical embolectomy or catheter-directed therapy is recommended in patients with an absolute contraindication to systemic thrombolysis. Extracorporeal membrane oxygenation (ECMO) provides respiratory and hemodynamic support for the most critically ill PE patients with refractory cardiogenic shock or cardiac arrest. The complex management of these individuals requires urgent yet coordinated multidisciplinary care. In light of existing evidence regarding the utility of ECMO in the management of high-risk PE patients, a number of possible indications for ECMO utilization have been suggested in the literature. Specifically, in patients with refractory cardiac arrest, resuscitated cardiac arrest, or refractory shock, including in cases of failed thrombolysis, venoarterial ECMO (VA-ECMO) should be considered, either as a bridge to percutaneous or surgical embolectomy or as a bridge to recovery after surgical embolectomy. We review here the current evidence on the use of ECMO as part of the management strategy for the highest-risk presentations of PE and summarize the latest data in this indication.

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Section: Introductionmentioning

confidence: 99%

Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence

Chopard,

Morillo,

Meneveau

et al. 2024

Hamostaseologie

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“…3,4 Alternatively, prognostication may identify hemodynamically stable patients at higher risk of early decompensation or death (i.e., European Society of Cardiology [ESC] PE guideline intermediate-high risk subgroup) who may benefit from continued or more intensive surveillance and possibly additional treatment(s) beyond anticoagulation. 5,6 Clinical practice guidelines have suggested different approaches to identify intermediate-high risk patients who have acute PE and hemodynamic stability. 1 Some propose a combination of myocardial injury and right ventricle (RV) dysfunction to identify such patients, since those factors do predict the risk to some extent.…”

Section: Introductionmentioning

confidence: 99%

“…3 4 Alternatively, prognostication may identify hemodynamically stable patients at higher risk of early decompensation or death (i.e., European Society of Cardiology [ESC] PE guideline intermediate-high risk subgroup) who may benefit from continued or more intensive surveillance and possibly additional treatment(s) beyond anticoagulation. 5 6…”

Section: Introductionmentioning

confidence: 99%

National Early Warning Score-2 for Identification of Patients with Intermediate-High-Risk Pulmonary Embolism

Rodrı́guez

Muriel

Páez

et al. 2023

Semin Thromb Hemost

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Consensus statements have proposed the use of the National Early Warning Score 2 (NEWS2) to identify stable patients with acute pulmonary embolism (PE) and an intermediate-high risk of adverse outcomes. We aimed to externally validate NEWS2 and compare it to another predictive score (Bova). Using NEWS2 (cutoff ≥5 and ≥7) and the Bova score (cutoff >4), we classified patients as intermediate-high risk (vs. non-intermediate-high risk), and we compared the test characteristics of these risk classification tools for a complicated course within 30 days after PE diagnosis. We also assessed the validity of NEWS2 for predicting a complicated course by adding the results of echocardiography and troponin testing to the model. Of the 848 enrolled patients, the NEWS2 score ≥5 classified 471 (55.5%) and the Bova score classified 37 (4.4%) as intermediate-high risk. NEWS2 had a significantly lower specificity for a 30-day complicated course than Bova (45.4 vs. 96.3%, respectively; p < 0.001). Using the higher score threshold (≥7), the NEWS2 classified 99 (11.7%) as intermediate-high risk, and the specificity was 88.9% (difference with Bova, 7.4%; p < 0.001). The proportion of patients with intermediate-high risk PE was 2.4% for the combination of a positive troponin testing and echocardiographic right ventricle dysfunction and a positive NEWS2 (score ≥7), while the specificity was 97.8% (difference with Bova, 1.5%; p = 0.07). Bova outperforms NEWS2 for predicting a complicated course among stable patients with PE. Addition of troponin testing and echocardiography improved the specificity of NEWS2, although it was not superior to Bova. ClinicalTrials.gov number: NCT02238639.

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“…Dentre as características descritivas da patogenia da trombose, destaca-se a tríade de Virchow, a qual corresponde a um estado de hipercoagulabilidade, lesão endotelial e estase sanguínea. Quando ocorre a migração dos trombos para as artérias pulmonares (TEP), observa-se um aumento da pós carga do ventrículo direito (VD), podendo causar repercussão hemodinâmica, dilatação dessa câmara cardíaca, disfunção, isquemia ou, em casos mais graves, falência (GUIMARÃES et al, 2014;GARRISON & PENDELA & MEMON, 2021;POOR & VENTETUOLO, 2012).…”

Section: Introductionunclassified

“…No caso dos trombos menores que alcançam a circulação pulmonar, geralmente não há alterações hemodinâmicas graves. A intensidade dos sintomas está diretamente relacionada com a carga tromboembólica (GUIMARÃES et al, 2014;GARRISON & PENDELA & MEMON, 2021;POOR & VENTETUOLO, 2012).…”

Section: Introductionunclassified

Tromboembolismo Pulmonar Como Fator De Predisposição a Cor Pulmonale: Uma Revisão De Literatura

LANZA BAGNO,

DE PAULA MARTINS,

LUCAS BAHIA CARVALHO

et al. 2023

Estudos Multidisciplinares Sobre Emergência E Terapia Intensiva

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Objetivo: Revisar publicações abordando tromboembolismo pulmonar como fator de predisposição a cor pulmonale. Analisar a associação entre essas condições clínicas com objetivo de fornecer evidências científicas para auxiliar na investigação, no diagnóstico e no tratamento de pacientes acometidos. Metodologia: Revisão de literatura a partir de artigos científicos e bibliografias, retirados das bases de dados PubMed e Scielo, publicados nas línguas português e inglês entre os anos 2012 e 2022. Os descritores aplicados foram "Tromboembolismo pulmonar"; "Pulmonary embolism"; "Cor pulmonale"; "Terapia intensiva"; "Hipertensão pulmonar". Resultados e Discussão: O tromboembolismo pulmonar (TEP) é uma condição grave que, quando extensa ou recorrente, pode levar ao desenvolvimento de cor pulmonale, uma complicação grave caracterizada pelo aumento da pressão na artéria pulmonar e no ventrículo direito. A associação entre TEP e cor pulmonale é uma preocupação significativa, e a identificação precoce, aliada ao tratamento adequado do TEP, pode ajudar a prevenir o desenvolvimento de cor pulmonale nesse quadro. O diagnóstico de embolia pulmonar (EP) requer a avaliação de fatores de risco por meio de escores, mas estes não o confirmam. Os fatores de risco da EP podem ser herdados ou adquiridos, e o diagnóstico requer uma angiotomografia computadorizada pulmonar. A análise laboratorial e de imagem auxilia nesse processo. Diagnósticos diferenciais devem ser considerados e o tratamento deve ser realizado por uma equipe multidisciplinar. O objetivo do tratamento é controlar a doença subjacente e melhorar a função do ventrículo direito. Considerações Finais: O diagnóstico do tromboembolismo pulmonar e do cor pulmonale pode ser desafiador devido aos sintomas inespecíficos e semelhanças com outras condições cardiorrespiratórias. A associação entre esses quadros, juntamente com a detecção precoce, é essencial para prevenir danos permanentes. A importância de entender os mecanismos fisiopatológicos das condições é a base das pesquisas atuais que visam melhorar o tratamento.

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[Translated article] Multidisciplinary consensus for the management of pulmonary thromboembolism

Cited by 11 publications

References 36 publications

Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence

Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence

National Early Warning Score-2 for Identification of Patients with Intermediate-High-Risk Pulmonary Embolism

Tromboembolismo Pulmonar Como Fator De Predisposição a Cor Pulmonale: Uma Revisão De Literatura

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