Management of Pulmonary Embolism: An Update

Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibr...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2016-03, Vol.67 (8), p.976-990
Main Authors: Konstantinides, Stavros V, Barco, Stefano, Lankeit, Mareike, Meyer, Guy
Format: Article
Language:English
Subjects:
Age
Algorithms
Anticoagulants
Anticoagulants - therapeutic use
Cancer
Cancer therapies
Cardiology
Classification
Clinical medicine
Diagnostic Imaging - methods
Disease
Disease Management
Embolisms
FDA approval
Global Health
Humans
Medical imaging
Morbidity - trends
Mortality
Nonsteroidal anti-inflammatory drugs
Pulmonary arteries
Pulmonary Embolism - diagnosis
Pulmonary Embolism - drug therapy
Pulmonary Embolism - epidemiology
Survival Rate - trends
Thromboembolism
Thrombolytic Therapy - methods
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Summary:Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE; catheter-directed techniques are an option for patients with hemodynamic decompensation and high bleeding risk. New oral anticoagulant agents are effective and safe alternatives to standard anticoagulation regimens. Recent trial data do not support insertion of cava filters in patients who can receive anticoagulant treatments. Remaining areas of uncertainty include the therapeutic implications of subsegmental PE, the optimal diagnostic approach to the pregnant patient with suspected PE, and the efficacy and safety of new oral anticoagulant agents in patients with cancer. Campaigns to increase awareness combined with strategies to implement guideline recommendations will be crucial steps towards further optimizing management of acute PE.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2015.11.061