6533b7d6fe1ef96bd1267195
RESEARCH PRODUCT
Risk-adapted management of pulmonary embolism
Stavros KonstantinidesStavros KonstantinidesBarco Stefanosubject
Riskmedicine.medical_specialtyVentricular Dysfunction Rightmedicine.medical_treatmentHemorrhage030204 cardiovascular system & hematologyDabigatran03 medical and health scienceschemistry.chemical_compound0302 clinical medicineEdoxabanInternal medicinemedicineHumansThrombolytic Therapy030212 general & internal medicineIntensive care medicineRivaroxabanbusiness.industryAnticoagulantsDisease ManagementHematologyThrombolysisPrognosismedicine.diseasePulmonary embolismchemistryCirculatory systemCardiologyApixabanPulmonary EmbolismbusinessMajor bleedingmedicine.drugdescription
The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE. Catheter-directed pharmacomechanical reperfusion treatment represents a promising option for minimizing bleeding risk; for reduced-dose intravenous thrombolysis, the data are still preliminary. Non-vitamin K-dependent oral anticoagulants, directly inhibiting factor Xa (rivaroxaban, apixaban, edoxaban) or thrombin (dabigatran), have simplified initial and long-term anticoagulation for PE while reducing major bleeding risk. Use of vena cava filters should be restricted to selected patients with absolute contraindications to anticoagulation, or PE recurrence despite adequately dosed anticoagulants.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-03-01 | Thrombosis Research |