Management of Acute Pulmonary Embolism
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SECONDARY PREVENTION AND INTERVENTION (D. STEINBERG, SECTION EDITOR)
Management of Acute Pulmonary Embolism Connor Tice 1 & Matthew Seigerman 2,3,4 Taisei Kobayashi 2,3,4,5
&
Paul Fiorilli 2,3,4 & Steven C. Pugliese 5 & Sameer Khandhar 6 & Jay Giri 2,3,4,5 &
Accepted: 28 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review Over 100,000 cardiovascular-related deaths annually are caused by acute pulmonary embolism (PE). While anticoagulation has historically been the foundation for treatment of PE, this review highlights the recent rapid expansion in the interventional strategies for this condition. Recent Findings At the time of diagnosis, appropriate risk stratification helps to accurately identify patients who may be candidates for advanced therapeutic interventions. While systemic thrombolytics (ST) is the mostly commonly utilized intervention for high-risk PE, the risk profile of ST for intermediate-risk PE limits its use. Assessment of an individualized patient risk profile, often via a multidisciplinary pulmonary response team (PERT) model, there are various interventional strategies to consider for PE management. Novel therapeutic options include catheter-directed thrombolysis, catheter-based embolectomy, or mechanical circulatory support for certain high-risk PE patients. Current data has established safety and efficacy for catheterbased treatment of PE based on surrogate outcome measures. However, there is limited long-term data or prospective comparisons between treatment modalities and ST. While PE diagnosis has improved with modern cross-sectional imaging, there is interest in improved diagnostic models for PE that incorporate artificial intelligence and machine learning techniques. Summary In patients with acute pulmonary embolism, after appropriate risk stratification, some intermediate and high-risk patients should be considered for interventional-based treatment for PE. Keywords Pulmonary embolism . Catheter-directed thrombolysis . Catheter-directed embolectomy . Pulmonary embolism response team
Connor Tice and Matthew Seigerman contributed equally to this work. This article is part of the Topical Collection on Secondary Prevention and Intervention * Taisei Kobayashi [email protected] 1
Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
2
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
3
Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PA 19104, USA
4
Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Philadelphia, PA, USA
5
Division of Pulmonology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
6
Division of Cardiovascular Medicine, Penn Presbyterian Medical Center, Philadelphia, PA 19104, USA
Introduction While pulmonary embolism (PE) results in more than 100,000 cardiovascul
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