Management of pulmonary embolism: recent evidence and the new European guidelines

Konstantinides, Stavros; Torbicki, Adam

doi:10.1183/09031936.00180414

Cited by 8 publications

(8 citation statements)

References 35 publications

(32 reference statements)

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“…Regarding thromboembolic phenomenon management, prolonged treatment with anticoagulants is necessary. Both American and European guidelines [ 37 , 38 ] recommend at least three months of anticoagulant therapy, after which time the risk–benefit of continued treatment is necessary. This last point is important as the ACE-IPF study [ 16 ] showed that warfarin increased mortality in progressive IPF with no benefits of therapy in those patients who had no other indication for anticoagulation therapy.…”

Section: Comorbiditiesmentioning

confidence: 99%

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

et al. 2018

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal disease. The treatment is challenging and nowadays a comprehensive approach based not only in pharmacological strategies is necessary. Identification and control of comorbidities, non-pharmacological treatment, prevention and management of exacerbations as well as other areas of care (social, psychological) are fundamental for a holistic management of IPF. Gastroesophageal reflux, pulmonary hypertension, obstructive sleep apnea, combined with emphysema, lung cancer and cardiovascular involvement are the main comorbidities associated with IPF. Non-pharmacological treatment includes the use of oxygen in patients with rest or nocturnal hypoxemia and other support therapies such as non-invasive ventilation or even a high-flow nasal cannula to improve dyspnea. In some patients, lung transplant should be considered as this enhances survival. Pulmonary rehabilitation can add benefits in outcomes such control of dyspnea, exercise capacity distance and, overall, improve the quality of life; therefore it should be considered in patients with IPF. Also, multidisciplinary palliative care programs could help with symptom control and psychological support, with the aim of maintaining quality of life during the whole process of the disease. This review intends to provide clear information to help those involved in IPF follow up to improve patients’ daily care.

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Section: Comorbiditiesmentioning

confidence: 99%

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

et al. 2018

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“…11 Furthermore, in the setting of acute PE, the presence of RV dysfunction without evidence of hemodynamic compromise has been associated with a 2- to 10-fold higher risk of early mortality, compared with normotensive patients with acute PE but without RV dysfunction. 6 …”

Section: Introductionmentioning

confidence: 99%

“…Clinical suspicion for the presence of RV failure should be for every patient admitted with acute PE, regardless of initial hemodynamic stability. 6 , 7 , 9 …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] RV dysfunction will require the presence of at least one of the following: Current management guidelines state systemic administration of antithrombolytic therapy be reserved for patients with "high-risk" or "massive" PE causing hemodynamic instability. [6][7][8] Conversely, patients with "low-risk" PEs are typically ideal candidates for outpatient management. 7,9 Adding to the complexity of PE risk-stratification is the "intermediate-risk" or "submassive" presentations.…”

Section: Introductionmentioning

confidence: 99%

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Use of Tachycardia in Patients With Submassive Pulmonary Emboli to Risk Stratify for Early Initiation of Thrombolytic Therapy: A Case Series Comparing Early Versus Late Thrombolytic Initiation

Cheta

Long

Marik

2017

Journal of Investigative Medicine High Impact Case Reports

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Pulmonary embolism (PE) represents a prevalent cause of morbidity and mortality in the United States, with approximately 600 000 cases diagnosed annually. The mortality rate for untreated PE is as high as 30%. Right ventricular (RV) dysfunction is a sign of possible adverse outcomes with right-sided heart failure being the usual cause of death from PE. There is a spectrum of clinical presentations associated with PE diagnoses, from incidental and asymptomatic to rapid hemodynamic collapse. Despite successes in identifying patients with “high-risk” PEs for aggressive thrombolytic interventions and “low-risk” PEs for outpatient anticoagulation, a significant lack of consensus exists regarding intervention modalities for PEs identified as “intermediate risk” or “submassive,” defined as normotensive (systolic blood pressure ≥90 mm Hg) with acute RV dysfunction and myocardial injury. In this case series, we review the management and outcomes of 2 patients with submassive PEs and sustained tachycardia in the setting of normal blood pressures, and we address the need to recognize tachycardia as an ominous RV compensatory sign, indicative of impending hemodynamic collapse, that should lead to aggressive therapy with vascular intervention.

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“…Positive D-dimer or high Wells score warrants further investigation. Current gold standard to confirm or exclude PE is a computed tomography pulmonary angiogram (CTPA) (Konstantinides & Torbicki, 2014). In over 75% of all CTPAs requested due to suspected PE, the disease can be safely ruled out (Stein et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

The T_L,NO/T_L,CO ratio cannot be used to exclude pulmonary embolism

Fabius

Eijsvogel

Lee

et al. 2015

Clin Physio Funct Imaging

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Management of pulmonary embolism: recent evidence and the new European guidelines

Cited by 8 publications

References 35 publications

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

Use of Tachycardia in Patients With Submassive Pulmonary Emboli to Risk Stratify for Early Initiation of Thrombolytic Therapy: A Case Series Comparing Early Versus Late Thrombolytic Initiation

The T_L,NO/T_L,CO ratio cannot be used to exclude pulmonary embolism

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Management of pulmonary embolism: recent evidence and the new European guidelines

Cited by 8 publications

References 35 publications

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

Use of Tachycardia in Patients With Submassive Pulmonary Emboli to Risk Stratify for Early Initiation of Thrombolytic Therapy: A Case Series Comparing Early Versus Late Thrombolytic Initiation

The TL,NO/TL,CO ratio cannot be used to exclude pulmonary embolism

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The T_L,NO/T_L,CO ratio cannot be used to exclude pulmonary embolism