PDF icon PDF herunterladen
Semin Thromb Hemost 2023; 49(08): 785-796
DOI: 10.1055/s-0043-1772840
Review Article

Advanced Treatment of Hemodynamically Unstable Acute Pulmonary Embolism and Clinical Follow-up

Brian Fulton
1   Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Riyaz Bashir
2   Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
,
Mitchell D. Weinberg
3   Zucker School of Medicine at Hofstra/Northwell, Staten Island University Hospital, Staten Island, New York
,
Vladimir Lakhter
2   Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
,
Parth Rali
4   Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
,
Steve Pugliese
5   Division of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Jay Giri
1   Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
6   Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania
,
Taisei Kobayashi
1   Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
6   Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints
Preview

Abstract

High-risk acute pulmonary embolism (PE), defined as acute PE associated with hemodynamic instability, remains a significant contributor to cardiovascular morbidity and mortality in the United States and worldwide. Historically, anticoagulant therapy in addition to systemic thrombolysis has been the mainstays of medical therapy for the majority of patients with high-risk PE. In efforts to reduce the morbidity and mortality, a wide array of interventional and surgical therapies has been developed and employed in the management of these patients. However, the most recent guidelines for the management of PE have reserved the use of these advanced therapies in scenarios where thrombolytic therapy plus anticoagulation are unsuccessful. This is due largely to the lack of prospective, randomized studies in this population. Stemming from this, the approach to treatment of these patients varies widely depending on institutional experience and resources. Furthermore, morbidity and mortality remain unacceptably high in this population, with estimated 30-day mortality of at least 30%. As such, development of a standardized approach to treatment of these patients is paramount to improving outcomes. Early and accurate risk stratification in conjunction with a multidisciplinary team approach in the form of a PE response team is crucial. With the advent of novel therapies for the treatment of acute PE, in addition to the growing availability of and familiarity with mechanical circulatory support systems, such a standardized approach may now be within reach.

Keywords

high-risk pulmonary embolism - catheter-based embolectomy - catheter-based thrombolysis - surgical embolectomy - mechanical circulatory support


Publikationsverlauf

Artikel online veröffentlicht:
11. September 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA