Intermediate-Risk Pulmonary Embolism: A Review of Contemporary Diagnosis, Risk Stratification and Management

Balakrishna, Akshay Machanahalli; Reddi, Vuha; Belford, P. Matthew; Alvarez, Manrique; Zhao, David; Vallabhajosyula, Saraschandra

doi:10.3390/medicina58091186

Cited by 14 publications

(5 citation statements)

References 91 publications

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“…A study involving 62 institutions on IVCF placement indicated thrombosis in 78 cases (1.3%) [50] . A meta-analysis concluded that IVCF placement plays a role in reducing the short-term risk of subsequent PE but increases the long-term risk of VTE; thus, IVCF should be retrieved as soon as it is no longer needed [47,51] .…”

Section: Management Of Vte In Tbi Patientsmentioning

confidence: 99%

“…However, the initiation of anticoagulation therapy should not be unnecessarily delayed, and there is no evidence to support using IVCF as an adjunct to anticoagulant therapy [39,40] . Studies indicate that IVCF placement signi cantly reduces the risk of recurrent PE, increases the risk of DVT, but does not signi cantly affect overall mortality regardless of lter use [40,[45][46][47] . Complications associated with IVCF include thrombosis, IVC penetration, perforation, lter fracture, or migration [47,48] .…”

Section: Management Of Vte In Tbi Patientsmentioning

confidence: 99%

“…Studies indicate that IVCF placement signi cantly reduces the risk of recurrent PE, increases the risk of DVT, but does not signi cantly affect overall mortality regardless of lter use [40,[45][46][47] . Complications associated with IVCF include thrombosis, IVC penetration, perforation, lter fracture, or migration [47,48] . A single-center study reported a total complication rate of 10-20.6% for lters, with thrombotic complications constituting a signi cant percentage of these adverse events.…”

Section: Management Of Vte In Tbi Patientsmentioning

confidence: 99%

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A Challenging Case of Anticoagulation: Acute Traumatic Brain Injury Complicated by Multifocal Venous Thromboembolism

Shen,

Ou,

Chen

et al. 2024

Preprint

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Traumatic brain injury (TBI) poses a significant threat to human health and well-being, imposing substantial burdens on patients, families, and society at large. The mechanisms underlying coagulopathy induced by TBI remain elusive. Given the risk of exacerbated intracranial hemorrhage in the early stages of TBI, the initiation of anticoagulant therapy is often deferred. However, TBI is an independent risk factor for venous thromboembolism (VTE), and delaying anticoagulation increases the risk of VTE incidence and mortality. The early risk of hemorrhage and thrombosis presents a considerable challenge to treatment. This paper presents a case study of a 51-year-old male patient in the acute phase of TBI, complicated by extensive pulmonary embolism (PE) and deep vein thrombosis (DVT), treated with the insertion of an inferior vena cava filter (IVCF) followed by complications of IVCF thrombosis. Through this case and a review of relevant literature, we argue that anticoagulant therapy can be considered 7-14 days post-TBI based on individual circumstances. After IVCF placement, attention must be paid to complications, especially IVCF thrombosis.

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Section: Management Of Vte In Tbi Patientsmentioning

confidence: 99%

Section: Management Of Vte In Tbi Patientsmentioning

confidence: 99%

Section: Management Of Vte In Tbi Patientsmentioning

confidence: 99%

See 1 more Smart Citation

A Challenging Case of Anticoagulation: Acute Traumatic Brain Injury Complicated by Multifocal Venous Thromboembolism

Shen,

Ou,

Chen

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…High-risk APE, which constitutes less than 10% of cases, demands urgent reperfusion therapy to avert imminent mortality [ 5 ]. Although systemic thrombolysis is recommended for these patients, the actual application is limited due to the high risk of haemorrhagic complications or the presence of contraindications in a significant subset of patients [ 6 ]. Furthermore, about 8% of those treated with systemic thrombolysis experience delayed therapeutic responses.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

Elheet,

Elhadidy,

Farrag

et al. 2024

Cureus

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Background: Acute pulmonary embolism (APE) poses a significant risk to patient health, with treatment options varying in efficacy and safety. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has emerged as a potential alternative to conventional catheter-directed thrombolysis (CDT) for patients with intermediate to high-risk APE. This study aimed to compare the efficacy and safety of USCDT versus conventional CDT in patients with intermediate to high-risk APE. Methods: This observational retrospective study was conducted at the Armed Forces Hospital, Al-Hada, Taif, the Kingdom of Saudi Arabia (KSA), on 135 patients diagnosed with APE and treated with either USCDT or CDT (58 underwent CDT, while 77 underwent USCDT). The primary efficacy outcome was the change in the right ventricle to the left ventricle (RV/LV) diameter ratio. Secondary outcomes included changes in pulmonary artery systolic pressure and the Miller angiographic obstruction index score. Safety outcomes focused on major bleeding events. Results: Both USCDT and CDT significantly reduced RV/LV diameter ratio (from 1.35 ± 0.14 to 1.05 ± 0.17, P < 0.001) and systolic pulmonary artery pressure (SPAP) (from 55 ± 7 mmHg to 38 ± 7 mmHg, P < 0.001) at 48- and 12-hours post-procedure, respectively, with no significant differences between treatments. However, USCDT was associated with a significantly lower rate of major bleeding events compared to CDT (0% vs. 3.4%, P = 0.008). Multivariate logistic regression analysis revealed that USCDT was associated with a 71.9% risk reduction of bleeding (OR = 0.281, 95% CI = 0.126 - 0.627, P = 0.002). Conclusions: USCDT is a safe and effective alternative to CDT for the treatment of intermediate to high-risk APE, as it significantly reduces the risk of major bleeding.

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“…Among hemodynamically stable patients, PE is considered low-risk if there is no evidence of right heart strain, and intermediate-risk in the presence of right heart strain identified through imaging, cardiac biomarker, and/or echocardiographic changes. PE is classified as high-risk when there is hemodynamic instability [ 5 ]. Appropriately categorizing a patient with PE as high-risk, intermediate-risk, or low-risk at the time of their presentation is uniquely impactful for early triage and treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

The Role of IVC Filters in the Management of Acute Pulmonary Embolism

Asmar,

Michael,

Gallo

et al. 2024

JCM

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Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a prevalent cardiovascular condition, ranking third globally after myocardial infarction and stroke. The risk of VTE rises with age, posing a growing concern in aging populations. Acute PE, with its high morbidity and mortality, emphasizes the need for early diagnosis and intervention. This review explores prognostic factors for acute PE, categorizing it into low-risk, intermediate-risk, and high-risk based on hemodynamic stability and right ventricular strain. Timely classification is crucial for triage and treatment decisions. In the contemporary landscape, low-risk PE patients are often treated with Direct Oral Anticoagulants (DOACS) and rapidly discharged for outpatient follow-up. Intermediate- and high-risk patients may require advanced therapies, such as systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy, and IVC filter placement. The latter, particularly IVC filters, has witnessed increased usage, with evolving types like retrievable and convertible filters. However, concerns arise regarding complications and the need for timely retrieval. This review delves into the role of IVC filters in acute PE management, addressing their indications, types, complications, and retrieval considerations. The ongoing debate surrounding IVC filter use, especially in patients with less conventional indications, reflects the need for further research and data. Despite complications, recent studies suggest that clinically significant issues are rare, sparking discussions on the appropriate and safe utilization of IVC filters in select PE cases. The review concludes by highlighting current trends, gaps in knowledge, and potential avenues for advancing the role of IVC filters in future acute PE management.

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Intermediate-Risk Pulmonary Embolism: A Review of Contemporary Diagnosis, Risk Stratification and Management

Cited by 14 publications

References 91 publications

A Challenging Case of Anticoagulation: Acute Traumatic Brain Injury Complicated by Multifocal Venous Thromboembolism

A Challenging Case of Anticoagulation: Acute Traumatic Brain Injury Complicated by Multifocal Venous Thromboembolism

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism

The Role of IVC Filters in the Management of Acute Pulmonary Embolism

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