Title:Acute Phase Treatment of Pulmonary Embolism
Volume: 12
Issue: 3
Author(s): George Chalikias and Stavros Konstantinides
Affiliation:
Keywords:
Pulmonary embolism, venous thromboembolism, thrombolysis, heparin, anticoagulants.
Abstract: Pulmonary embolism (PE) is a common and potentially life threatening disease if left untreated. This is due to a
natural tendency towards early recurrence of pulmonary emboli which may lead to right ventricular failure. Thus, anticoagulant
treatment should be administered to all patients upon high or intermediate clinical probability of acute PE, while awaiting
definitive confirmation by imaging procedures. With the exception of severe renal impairment, high bleeding risk, arterial
hypotension, and extremes of body weight and age, unfractionated heparin has been replaced by low molecular-weight heparin
or fondaparinux given subcutaneously at weight-adjusted doses. In hemodynamically unstable patients with confirmed
(high-risk) PE, thrombolysis should be administered without delay; if thrombolysis is absolutely contraindicated or has failed,
surgical embolectomy or catheter-based thrombus removal is a valuable alternative. In normotensive (non-high-risk) patients,
low-molecular-weight heparin or fondaparinux is adequate treatment in most cases, and thrombolysis is generally not recommended
as a first-line therapeutic option. An ongoing randomized trial will determine whether normotensive patients with
evidence of right ventricular dysfunction plus myocardial injury may benefit from early thrombolysis. Finally, selected normotensive
patients without serious comorbidity or signs of heart failure (low-risk PE) may be candidates for out-of-hospital
treatment. This strategy may be facilitated by the use of new oral anticoagulants in the future.
