Management of venous thromboembolisms: Part ii. the consensus for pulmonary embolism and updates
Journal
Acta Cardiologica Sinica
Journal Volume
36
Journal Issue
6
Pages
562-582
Date Issued
2020
Author(s)
Wang K.-L.
Kao Y.-T.
Chang H.-Y.
Huang W.-C.
Hsu P.-C.
Hsu C.-H.
Huang C.-L.
Hsieh L.-C.
Wang C.-Y.
Lin T.-H.
Chiu K.-M.
Chu P.-H.
Abstract
Pulmonary embolism (PE) is a potential life-threatening condition and risk-adapted diagnostic and therapeutic management conveys a favorable outcome. For patients at high risk for early complications and mortality, prompt exclusion or confirmation of PE by imaging is the key step to initiate and facilitate reperfusion treatment. Among patients with hemodynamic instability, systemic thrombolysis improves survival, whereas surgical embolectomy or percutaneous intervention are alternatives in experienced hands in scenarios where systemic thrombolysis is not the best preferred thromboreduction measure. For patients with suspected PE who are not at high risk for early complications and mortality, the organized approach using a structured evaluation system to assess the pretest probability, the age-adjusted D-dimer cut-offs, the appropriate selection of imaging tools, and proper interpretation of imaging results is important when deciding the allocation of treatment strategies. Patients with PE requires anticoagulation treatment. In patients with cancer and thrombosis, low-molecular-weight heparin (LMWH) used to be the standard regimen. Recently, three factor Xa inhibitors collectively show that non-vitamin K oral anticoagulants (NOACs) are as effective as LMWH in four randomized clinical trials. Therefore, NOACs are suitable and preferred in most conditions. Finally, chronic thromboembolic pulmonary hypertension is the most disabling long-term complication of PE. Because of its low incidence, the extra caution should be given when managing patients with PE. ? 2020, Republic of China Society of Cardiology. All rights reserved.
SDGs
Other Subjects
acetylsalicylic acid; alteplase; anticoagulant agent; antivitamin K; apixaban; blood clotting factor 10a inhibitor; brain natriuretic peptide; copeptin; cystatin C; D dimer; dabigatran; dalteparin; edoxaban; enoxaparin; glycoprotein P inhibitor; heparin; low molecular weight heparin; neutrophil gelatinase associated lipocalin; rivaroxaban; tenecteplase; activated partial thromboplastin time; algorithm; bleeding; blood clot lysis; brain ventricle dilatation; cancer associated thrombosis; cardiography; clinical assessment; clinical outcome; clinical trial (topic); computed tomography pulmonary angiography; computer assisted tomography; consensus development; continuous infusion; dyspnea; electrocardiography; embolectomy; extracorporeal oxygenation; functional status; gastrointestinal hemorrhage; heart arrest; heart left ventricle failure; hemodynamics; human; hypotension; intervention study; leg swelling; low drug dose; lung embolism; lung ventilation; mortality; mortality rate; oxygen saturation; predictive value; probability; pulmonary embolism response team; pulse rate; randomized controlled trial (topic); reperfusion; Review; scintigraphy; scoring system; single drug dose; sonothrombolysis; tachycardia; tachypnea; thrombocytopenia; thrombosis; transthoracic echocardiography; tricuspid annular plane systolic excursion; ultrasound; venous thromboembolism
Publisher
Republic of China Society of Cardiology
Type
review