Current Management of Acute Pulmonary Embolism

Abstract

Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy. Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade. Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter-guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism. Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients.

Management of Pulmonary Thromboembolism

“…d. Dobutamine in medium doses of up to 10 μg/kg/min can be considered as inotrope of choice. However, it should be kept in mind that, dobutamine administrated at improper high doses, increases perfusion of nonventilated regions of the lungs and may worsen respiratory insufficiency secondary to increased ventilation-perfusion (V/P) mismatch [5][6][7].…”

“…f. Based on minimal clinical data it may be suggested that if CO remains low despite vasopressors and inotropes, a pulmonary vasodilator trial with iNO may be beneficial when pulmonary hypertension is present [5][6][7][8].…”

“…The medical management [10][11][12][13][14][15][16][17][18][19][20][21][22] of acute PTE consists of anticoagulation and systemic thrombolysis. The rapid reversibility of IV UFH is important for these patients who may require thrombolysis or surgical embolectomy.…”

Therapeutic effect of SP‐8356 on pulmonary embolism‐associated cardiac injury is mediated by its ability to suppress apoptosis and inflammation

“…Acute pulmonary embolism (APE) 2 is one of the typical and most dangerous illnesses with a 30-day average death rate of ~10%. 1 The existence of right ventricular (RV) disorder is correlated to a considerable rise in hospitalization and mortality due to pulmonary embolism (PE). 1,2 Prior research shows that an inflammatory response is a crucial factor in the dysfunction of the right ventricle after APE.…”

Catheter-Directed Thrombectomy for Pulmonary Embolism in the Setting of Acute Stroke

“…Pulmonary embolism (PE) is the third-leading cause of cardiovascular-related death in the United States, accounting for around 100,000 deaths per year [ 1 ]. Specifically, massive (or high-risk) PE, defined as acute PE with sustained hypotension and hemodynamic instability, accounts for an estimated 4.5%-10% of all PE cases and has over 50% mortality [ 2 , 3 ]. Historically, the primary treatment options for PE have been anticoagulation therapy and systemic thrombolytic therapy.…”