Aggressive Treatment of Intermediate-Risk Patients with Acute Symptomatic Pulmonary Embolism

Abstract

Contemporary studies of acute pulmonary embolism (PE) have evaluated the role of thrombolytics in intermediate-risk PE. Significant findings are that thrombolytic therapy may prevent hemodynamic deterioration and all-cause mortality but increases major bleeding. Benefits and harms are finely balanced with no convincing net benefit from thrombolytic therapy among unselected patients. Among patients with intermediate risk PE, additional prognostic factors or subtle hemodynamic changes might alter the risk-benefit assessment in favor of thrombolytic therapy before obvious hemodynamic instability.

Thromboembolic Complications of SARS-CoV-2 and Metabolic Derangements: Suggestions from Clinical Practice Evidence to Causative Agents

“…IVC filters do not exonerate patients from the use of anticoagulation which must be restored immediately, with the dosage of the drug gradually increased whilst considering the potential to bleed. Patients with intermediate-risk and hemodynamically stable [52,[58][59][60] should be closely monitored and managed with anticoagulant therapy.…”

“…Rescue systemic fibrinolysis should be considered in patients with progressive deterioration, either systemically or by transcatheter approach. Instead, for patients with evident haemodynamic instability and high-risk PE [52,[58][59][60] systemic fibrinolysis is indicated with two possible options, a percutaneous catheter approach or if this is contraindicated, systemic fibrinolysis.…”

Tromboembolismo pulmonar agudo en tiempos de SARS-CoV-2: diagnóstico y tratamiento

“…Tratamiento percutáneo: las técnicas intravasculares han demostrado similar eficacia que los trombolíticos sistémicos y un mejor perfil de seguridad 18,52,53 . Sin embargo, su indicación debe limitarse durante la pandemia a pacientes con TEP de alto riesgo y contraindicación de trombolíticos o falla de éstos 18,[54][55][56] para reducir el riesgo de contagio del personal de salud. En caso confirmado de COVID-19 debe evitarse o diferirse hasta que el riesgo de infección lo permita, excepto en casos de TEP con descompensación hemodinámica resistente.…”

Pulmonary Embolism Prophylaxis in Patients With COVID-19: An Emerging Issue

“…Last, but not least, in patients with COVID-19 with refractory symptoms or when thrombolysis is contraindicated or has failed, pulmonary embolectomy might be beneficial. This procedure can be successfully performed with or without cardiopulmonary bypass; the bleeding risk is always manageable even under the most challenging circumstances [1,21,36].…”