Abstract
Acute pulmonary embolism (PE) is one of the most common causes of cardiovascular death. Most often acute PE is associated with under diagnosis, misdiagnosis and delay in diagnosis and management leading to high morbidity and mortality. PE outcomes will improve with proper evaluation of clinical symptoms and signs, relevant diagnostic tests, identifying high-risk patients suitable for early re-perfusion with I.V. or catheter-directed thrombolytic therapy or surgical embolectomy and in some cases additional use of mechanical circulatory support. During clinical evaluation modified Geneva score, Well’s score, and Simplified pulmonary embolism severity index (sPESI) scores are useful in assessing PE and its adverse outcomes. Hestia criteria are useful in identifying suitable for outpatient management of PE. Long-term management of PE involves identifying patients prone for recurrence and CTPE with appropriate long-term prophylaxis using oral anticoagulants.
Highlights
Acute pulmonary embolism (PE) is due to Deep Vein Thrombosis (DVT) embolism, i.e. blood clot or part of it breaks off from the vein
Patients When oral anticoagulation is started, in a patient with PE who is eligible for a NOAC (Apixaban, Dabigatran, Edoxaban, or Rivaroxaban), a NOAC is recommended in preference to a Vitamin K Antagonist (VKA)
Indefinite duration is recommended for recurrent Vein thrombus-embolism (VTE) not related to a significant transient or reversible risk factor and patients with antiphospholipid antibody syndrome
Summary
Acute pulmonary embolism (PE) is due to Deep Vein Thrombosis (DVT) embolism, i.e. blood clot or part of it breaks off from the vein. Every effort should be made to clear the clot as early as possible to improve acute hemodynamic status by reversing acute and sub-acute RV dysfunction, chronic thrombotic pulmonary embolism (CTPE), and lowering the mortality rate. Low-risk patients are without elevated Troponin-I, RV dysfunction, and PESI III to IV or SPESI ≥ 1. Intermediate risk group patients have increased troponin I or RV dysfunction with PESI III to IV or SPESI ≥ 1. Patients with none of the clinical variable (i.e., the total score of 0) are considered as low risk and have mortality and pulmonary embolism-related complication rates significantly lower as those with a score of ≥1. Acute PE without systemic hypotension (systolic blood pressure > 90 mm Hg) but with either RV dysfunction or elevated cardiac troponin levels include PESI/sPESI criteria
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